2.  Peer Reviewed Title: Highly active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda. Author: Andia I; Kaida A; Maier M; Guzman D; Emenyonu N; Pepper L; Bangsberg DR; Hogg RS Source: American Journal of Public Health. 2009 Feb;99(2):340-7. Abstract: OBJECTIVES: We investigated whether the prevalence of contraceptive use among women who are HIV positive varied according to use of highly active antiretroviral therapy (HAART) in Mbarara, Uganda. METHODS: We used data from a cross-sectional survey of 484 women who were HIV positive (18-50 years) and were attending Mbarara University's HIV clinic, 45% of whom were receiving HAART. Multivariate logistic regression was used to investigate the association between HAART use and contraceptive use. Data were collected between November 2005 and June 2006. RESULTS: Overall, 45% of the women were sexually active in the previous 3 months. Of these, 85% reported using contraceptive methods, with 84% reporting use of barrier contraceptive methods. Women receiving HAART were more than twice as likely to use contraceptive methods (adjusted odds ratio [AOR] = 2.64; 95% confidence interval [CI] = 1.07, 6.49) and more than 3 times as likely to use barrier contraceptive methods (AOR = 3.62; 95% CI = 1.54, 8.55) than were women not receiving HAART. CONCLUSIONS: Our findings support the need for increased attention to better integration of reproductive health and HIV and AIDS services for women who are HIV positive. Language: English Keywords: UGANDA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | WOMEN | CONTRACEPTIVE USAGE | ANTIRETROVIRAL THERAPY | REPRODUCTIVE HEALTH | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Contraception | Family Planning | HIV | Health | Program Evaluation | Programs | Organization and Administration Document Number: 329768 |
| 3. Peer Reviewed Title: Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa. Author: Bourne DE; Thompson M; Brody LL; Cotton M; Draper B; Laubscher R; Abdullah MF; Myers JE Source: AIDS. 2009 Jan 2;23(1):101-6. Abstract: OBJECTIVES: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. METHODS: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997-2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. RESULTS: Postneonatal mortality increased each year over the period 1997-2002. A peak in HIV-related deaths was observed, centred at 2-3 months of age, rising monotonically over time. CONCLUSION: We interpret the peak in mortality at 2-3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | LINEAR REGRESSION | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | AIDS | CAUSES OF DEATH | CHILD MORTALITY | VITAL STATISTICS | MOTHER-TO-CHILD TRANSMISSION | DEATH RATE | AGE SPECIFIC DEATH RATE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Statistical Regression | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Population Statistics | Transmission | Infections Document Number: 330334 |
| 4. Title: Henoch-Schonlein purpura and thrombocytopenia after planned antiretroviral treatment interruption in a Thai girl with HIV infection. Author: Bunupuradah T; Puthanakit T; Pancharoen C; Butterworth O; Phanuphak P; Ananworanich J Source: International Journal of Infectious Diseases. 2009 Jan;13(1):e31-3. Abstract: A handful of Henoch-Schonlein purpura (HSP) cases have been reported in HIV-infected adult patients. We report herein the case of an 11-year-old Thai girl with HIV infection, who developed severe abdominal pain and palpable purpura consistent with HSP, 3 months after planned antiretroviral treatment interruption (PTI). One month later she developed thrombocytopenia. It is possible that an HIV effect on vascular endothelium or PTI-associated immune activation contributed to HSP and thrombocytopenia. Language: English Keywords: THAILAND | RESEARCH REPORT | CHILDREN | PERSONS LIVING WITH HIV/AIDS | TREATMENT | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | IMMUNOLOGICAL EFFECTS | SIGNS AND SYMPTOMS | PAIN | Developing Countries | Asia, Southeastern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Behavior | Immunity | Immune System | Physiology | Biology Document Number: 329692 |
| 5. 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 |
| 6. Peer Reviewed Title: Estimation of the predictive role of plasma viral load on CD4 decline in HIV-1 subtype C-infected subjects in India. Author: Ding M; Tarwater P; Rodriguez M; Chatterjee R; Ratner D; Yamamura Y; Roy P; Mellors J; Neogi D; Chen Y; Gupta P Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):119-25. Abstract: BACKGROUND: Plasma viral load has been shown to be a meaningful prognostic marker for disease progression in untreated, HIV-1 subtype B-infected subjects in United States and Western Europe and therefore used as a prognostic marker for disease progression. Because of high expenses of commercially available viral load assays, the role of viral load in disease progression has not been evaluated in HIV-1 subtype C-infected patients in India. METHODS: We developed an inexpensive real-time reverse transcriptase-polymerase chain reaction assay to quantify viral load in plasma of HIV-1 subtype C-infected subjects from India and used it in a longitudinal analysis of viral load and CD4 cell number in HIV-infected subjects from Calcutta, India. RESULTS: The real-time reverse transcriptase-polymerase chain reaction assay can quantify plasma viral load with a linear range of detection from 10 to 10 HIV-1 RNA copies per input. Longitudinal analysis of viral load in a cohort of 39 subjects over an average period of approximately 3 years indicates that 1-log increase in HIV-1 RNA level was associated with a decline of 67 CD4 cell count. Furthermore, HIV-1 RNA level between 500 and 50,000 copies per milliliter would predict a 12.9% decrease in CD4 cell count per year, whereas HIV-1 RNA levels above 50,000 copies HIV-1 RNA per milliliter would predict a 25.3% decrease in CD4 cells per year. In addition, we estimated that the mean incubation period of disease development, as defined by the loss of CD4 below 200, is 8.2 years. CONCLUSION: Our report on the level of viral load on predicting CD4 decline in Indian subjects with HIV-1 provides an additional important tool to the physicians for treating and planning a therapeutic strategy to control HIV-1 infection in India. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | GENETIC TECHNIQUES | ESTIMATION TECHNIQUES | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | HIV INFECTIONS | COST EFFECTIVENESS | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNITY, CELLULAR | Developing Countries | Asia, Southern | Asia | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology Document Number: 330366 |
| 7. Title: Population pharmacokinetics of nevirapine in combination with rifampicin-based short course chemotherapy in HIV- and tuberculosis-infected South African patients. Author: Elsherbiny D; Cohen K; Jansson B; Smith P; McIlleron H; Simonsson US Source: European Journal of Clinical Pharmacology. 2009 Jan;65(1):71-80. Abstract: OBJECTIVE: The aim was to develop a model to describe the population pharmacokinetics of nevirapine in South African human immunodeficiency virus (HIV)-infected patients who were taking nevirapine-based antiretroviral therapy concomitantly or in the absence of rifampicin-based tuberculosis therapy. METHODS: Patients were divided into two groups: (1) patients receiving nevirapine-containing antiretroviral regimen (200 mg twice daily) and continuation phase rifampicin-containing tuberculosis therapy (n = 27) in whom blood samples were obtained before and not less than 14 days after they completed tuberculosis therapy; (2) patients without tuberculosis who were receiving a nevirapine-containing antiretroviral regimen for at least 3 weeks (n = 26). The population pharmacokinetics of nevirapine was described using nonlinear mixed effects modelling with NONMEM software. Based on the developed model, plasma concentration profiles after 300, 400 and 500 mg of nevirapine twice daily were simulated. RESULTS: Concomitant administration of rifampicin increased nevirapine oral clearance (CL/F) by 37.4% and reduced the absorption rate constant (k(a)) by almost sixfold. Rifampicin reduced the nevirapine average minimum concentration by 39%. Simulated doses of 300 mg twice daily elevated nevirapine concentrations above subtherapeutic levels in most patients, with minimum exposure above the recommended maximum concentration. The area under the concentration-time curve of 12-hydroxynevirapine was not different in the presence of rifampicin. 2-, 3- and 8-Hydroxynevirapine were not detectable (LLOQ = 0.025 mg/L). CONCLUSION: The developed model adequately describes nevirapine population pharmacokinetics in a South African population when taken with/and in the absence of rifampicin treatment. The simulations suggest that an increased dose of 300 mg twice daily would achieve adequate nevirapine concentrations in most patients during rifampicin-containing treatment for tuberculosis. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | ANTIRETROVIRAL DRUGS | DRUG INTERACTIONS | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs Document Number: 330217 |
| 8. Title: A prospective study evaluating clinical outcomes and costs of three NNRTI-based HAART regimens in Kerala, India. Author: George C; Yesoda A; Jayakumar B; Lal L Source: Journal of Clinical Pharmacy and therapeutics. 2009 Feb;34(1):33-40. Abstract: OBJECTIVE: This prospective, observational, study evaluates the clinical outcomes, drug utilization patterns, and adherence to treatment of patients on highly active anti retroviral therapy (HAART) at a government institution in Kerala, India. METHODS: Patients who met criteria for treatment of HIV/AIDS were enrolled into the study, given free NNRTI-based combination therapy, and were followed for a period of 6 months. Data regarding demographics, clinical outcome, laboratory results, drug utilization, adherence and adverse effects were collected. Analysis was conducted utilizing descriptive statistics, anova, Fisher-exact, andt-test. RESULTS: One hundred and forty-two patients with HIV-1 were enrolled in the study into three treatment groups. The mean age was 37.88 years, 64% of the patients were male, and 92% were married. Group 1 was given zidovudine, lamivudine, and nevirapine [n = 52 (37%)], group 2 was given lamivudine, stavudine, and nevirapine [n = 51 (36%)], and group 3 was given lamivudine, stavudine, and efavirenz [n = 39 (27%)]. The increase in CD4 was 107.46 (SD: 106.25). Mean medication adherence for the 104 patients who completed the study, was 90.7%; for group 1: 92.06%, group 2: 93.37%1, and group 3: 85.71% (P > 0.05). Forty (38%) patients have at least one adverse event to HARRT, with headache being the most common side effect (11.5%). Mortality rate was 3.5% during the course of the study. CONCLUSION: Provision of free NNRTI-based combination therapy to patients in Kerala, India, resulted in greater than 90% adherence leading to better clinical outcomes in terms of increasing CD4 counts and low mortality, for patients consistently attending a treatment clinic. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | COST BENEFIT ANALYSIS | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | COST EFFECTIVENESS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | HEADACHE | SIDE EFFECTS | DEATH RATE | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Evaluation Indexes | HIV | Behavior | Signs and Symptoms | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 330372 |
| 9. Title: Incidence of common opportunistic infections in HIV-infected individuals in Pune, India: analysis by stages of immunosuppression represented by CD4 counts. Author: Ghate M; Deshpande S; Tripathy S; Nene M; Gedam P; Godbole S; Thakar M; Risbud A; Bollinger R; Mehendale S Source: International Journal of Infectious Diseases. 2009 Jan;13(1):e1-8. Abstract: BACKGROUND: Opportunistic infections (OIs) influence the morbidity and mortality due to HIV infections. Data from India on the incidence of OIs among HIV-infected individuals by stages of immunodeficiency are scarce. METHODS: Between September 2002 and November 2004, HIV-infected individuals were enrolled in a prospective study in Pune. They were clinically and immunologically evaluated quarterly. Incidence rates of specific OIs were calculated. RESULTS: Median CD4 counts in HIV-infected male and female patients at baseline were 197/mm(3) and 413/mm(3), respectively. Tuberculosis was the most common OI with an incidence of 15.4 (95% CI 12.2-19.2) per 100 person-years, followed by oral candidiasis 11.3 (95% CI 8.6-14.5), herpes zoster 10.1 (95% CI 7.6-13.1), and cryptococcal meningitis 1.7 (95% CI 0.8-3.1) per 100 person-years. Patients with baseline CD4 counts of <200/mm(3) were six times more likely to develop OIs compared to those with CD4 counts of >350/mm(3) (p<0.001). CONCLUSIONS: The high incidence of commonly reported OIs in Indian HIV-infected individuals highlights the need for early screening and also the need to increase awareness in healthcare providers, in order to improve decisions regarding prophylaxis for prevention and appropriate therapeutic intervention. Emphasis needs to be given to the early diagnosis and management of tuberculosis in HIV-infected individuals. Language: English Keywords: INDIA | RESEARCH REPORT | INCIDENCE | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | HIV | IMMUNOLOGIC FACTORS | LABORATORY PROCEDURES | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 329688 |
| 10. Title: Factors associated with increased prevalence of human papillomavirus infection in a cohort of HIV-infected Brazilian women. Author: Grinsztejn B; Veloso VG; Levi JE; Velasque L; Luz PM; Friedman RK; Andrade AC; Moreira RI; Russomano F; Pilotto JH; Bastos FI; Palefsky J Source: International Journal of Infectious Diseases. 2009 Jan;13(1):72-80. Abstract: OBJECTIVES: Human papillomavirus (HPV) infection is a major risk factor for cervical disease. Using baseline data from the HIV-infected cohort of Evandro Chagas Clinical Research Institute at Fiocruz, Rio de Janeiro, Brazil, factors associated with an increased prevalence of HPV were assessed. METHODS: Samples from 634 HIV-infected women were tested for the presence of HPV infection using hybrid capture II and polymerase chain reaction. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance. RESULTS: The overall prevalence of HPV infection was 48%, of which 94% were infected with a high-risk HPV. In multivariate analysis, factors independently associated with infection with high-risk HPV type were: younger age (<30 years of age; PR 1.5, 95% confidence interval (CI) 1.1-2.1), current or prior drug use (PR 1.3, 95% CI 1.0-1.6), self-reported history of HPV infection (PR 1.2, 95% CI 0.96-1.6), condom use in the last sexual intercourse (PR 1.3, 95% CI 1.1-1.7), and nadir CD4+ T-cell count <100cells/mm(3) (PR 1.6, 95% CI 1.2-2.1). CONCLUSIONS: The estimated prevalence of high-risk HPV-infection among HIV-infected women from Rio de Janeiro, Brazil, was high. Close monitoring of HPV-related effects is warranted in all HIV-infected women, in particular those of younger age and advanced immunosuppression. Language: English Keywords: BRAZIL | RESEARCH REPORT | LABORATORY PROCEDURES | PREVALENCE | MULTIVARIATE ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | HPV | HIV | AGE FACTORS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Research Methodology | Data Analysis | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Population Characteristics Document Number: 329678 |
| 11. Peer Reviewed Title: Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu, China. Author: Guo H; Wei JF; Yang H; Huan X; Tsui SK; Zhang C Source: Sexually Transmitted Diseases. 2009 Feb;36(2):120-5. Abstract: OBJECTIVES: To investigate the prevalence of HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis among men who have sex with men (MSM) in 2 cities of Jiangsu, China, and to characterize the HIV-1 subtypes prevalent among this population. METHODS: During September 2006 and July 2007, 296 and 173 MSM were recruited from Nanjing and Yangzhou, respectively. Sera samples were collected and tested for HIV, HBV, HCV, and syphilis infections. The nucleotide sequences of p17 and C2V3 regions were determined by RT-nested-PCR and sequencing. HIV-1 subtypes were characterized by phylogenetic analysis. RESULTS: The prevalence of HIV, HBV, HCV, and syphilis infections among MSM was 5.8%, 11.1%, 0.7%, and 27.7%, respectively. The prevalence of HIV and syphilis was significantly higher in 2006-2007 than in 2003 (P Language: English Keywords: CHINA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | GENETIC TECHNIQUES | MEN HAVING SEX WITH MEN | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | PREVALENCE | HIV INFECTIONS | SYPHILIS | HEPATITIS | GENETICS | CHROMOSOME ABNORMALITIES | Asia, Eastern | Asia | Developing Countries | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sex Behavior | Behavior | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Biology | Neonatal Diseases and Abnormalities Document Number: 330373 |
| 12. Title: Monitoring HIV epidemics: declines in prevalence do not always mean good news [editorial] Author: Hallett T Source: AIDS. 2009 Jan 2;23(1):131-2. Abstract: The future of HIV epidemic monitoring is likely to rely on HIV prevalence for many years to come. After years of intensive research, direct measurements of incidence in local cohort studies are becoming less and less representative of whole countries, and assays that discriminate recent infections in cross-sectional serosurveys have been shown to be unreliable in African countries without calibration. Antiretroviral therapy will add a further layer of complexity, as longer survival times will tend to increase HIV prevalence; so that upturns in epidemics may not indicate increased risk behaviour, and stable prevalence rates could mask substantial reductions in incidence. It will, therefore, be essential to make maximum use of mathematical modelling in the interpretation of trends in HIV prevalence. To be conservative and defensible, these modelsmust reasonably account for all other potential sources of natural changes in epidemics, so that the contribution of actual reductions in risk-if any-can be resolved. And only from that starting point, can the important investigations into the proximal and distal causes and reasons for the behaviour changes begin. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | MONITORING | HIV INFECTIONS | EPIDEMIOLOGY | EPIDEMICS | RELIABILITY | VALIDITY | ERROR SOURCES | Africa | Developing Countries | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Public Health | Health Document Number: 330256 |
| 13. Peer Reviewed Title: High incidence of tuberculosis among HIV-infected infants: evidence from a South African population-based study highlights the need for improved tuberculosis control strategies. Author: Hesseling AC; Cotton MF; Jennings T; Whitelaw A; Johnson LF; Eley B; Roux P; Godfrey-Faussett P; Schaaf HS Source: Clinical Infectious Diseases. 2009 Jan 1;48(1):108-14. Abstract: BACKGROUND: There are limited population-based estimates of tuberculosis incidence among human immunodeficiency virus (HIV)-infected and HIV-uninfected infants aged < or =12 months. We aimed to estimate the population-based incidence of culture-confirmed tuberculosis among HIV-infected and HIV-uninfected infants in the Western Cape Province, South Africa. METHODS: The incidences of pulmonary, extrapulmonary, and disseminated tuberculosis were estimated over a 3-year period (2004-2006) with use of prospective representative hospital surveillance data of the annual number of culture-confirmed tuberculosis cases among infants. The total number of HIV-infected and HIV-uninfected infants was calculated using population-based estimates of the total number of live infants and the annual maternal HIV prevalence and vertical HIV transmission rates. RESULTS: There were 245 infants with culture-confirmed tuberculosis. The overall incidences of tuberculosis were 1596 cases per 100,000 population among HIV-infected infants (95% confidence interval [CI], 1151-2132 cases per 100,000 population) and 65.9 cases per 100,000 population among HIV-uninfected infants (95% CI, 56-75 cases per 100,000 population). The relative risk of culture-confirmed tuberculosis among HIV-infected infants was 24.2 (95% CI, 17-34). The incidences of disseminated tuberculosis were 240.9 cases per 100,000 population (95% CI, 89-433 cases per 100,000 population) among HIV-infected infants and 14.1 cases per 100,000 population (95% CI, 10-18 cases per 100,000 population) among HIV-uninfected infants (relative risk, 17.1; 95% CI, 6-34). CONCLUSIONS: This study indicates the magnitude of the tuberculosis disease burden among HIV-infected infants and provides population-based comparative incidence rates of tuberculosis among HIV-infected infants. This high risk of tuberculosis among HIV-infected infants is of great concern and may be attributable to an increased risk of tuberculosis exposure, increased immune-mediated tuberculosis susceptibility, and/or possible limited protective effect of bacille Calmette-Guerin vaccination. Improved tuberculosis control strategies, including maternal tuberculosis screening, contact tracing of tuberculosis-exposed infants coupled with preventive chemotherapy, and effective vaccine strategies, are needed for infants in settings where HIV infection and tuberculosis are highly endemic. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | INCIDENCE | INFANT | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | HIV TRANSMISSION | SCREENING | EXPOSURE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Infections | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Risk Factors | Biology Document Number: 329778 |
| 14. Peer Reviewed Title: Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. Author: Homsy J; Bunnell R; Moore D; King R; Malamba S; Nakityo R; Glidden D; Tappero J; Mermin J Source: PLoS One. 2009;4(1):e4149. Abstract: BACKGROUND: Antiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa. METHODOLOGY /PRINCIPAL FINDINGS: Using a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected women in rural Uganda who initiated ART between May 2003 and May 2004 and were followed up in their homes until June 2006. Women answered in-depth social and behavioral questionnaires administered every quarter in year 1 after initiating ART, and every 6 to 12 months thereafter. Use of family planning methods was assessed at 18 and 24 months after starting ART. We tested for non-constant pregnancy incidence by using a shape parameter test from the Weibull distribution. We modeled repeated measurements of all variables related to the women's desire for children over time using a generalized estimating equation (GEE) extension to the logistic regression model. Risk factors for pregnancy were examined using Cox proportional hazards model. 711 women eligible for the study were followed-up for a median time of 2.4 years after starting ART. During this time, less than 7% of women reported wanting more children at any time point yet 120 (16.9%) women experienced 140 pregnancies and pregnancy incidence increased from 3.46 per 100 women-years (WY) in the first quarter to 9.5 per 100 WY at 24 months (p<0.0001). This was paralleled by an increase in the proportion of women reporting sexual activity in the past 3 months, from 24.4% at baseline to 32.5% over 24 months of follow-up (p = 0.001). Only 14% of women used permanent or semi-permanent family planning methods by their second year on ART. In the multivariate model, younger age (HR = 2.71 per 10-year decrease, 95% CI: 2.95-3.78), having a BMI>18.5 (HR = 1.09, CI: 1.01-1.18) and not having used condoms consistently in the last 3 months (HR = 1.79, CI: 1.02-3.13) were independently associated with pregnancy. CONCLUSION/SIGNIFICANCE: Women on ART and their partners should be consistently counseled on the effects of ART in restoring fertility, and offered regularly free and comprehensive family planning services as part of their standard package of care. Language: English Keywords: UGANDA | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | PERSONS LIVING WITH HIV/AIDS | PREGNANCY | REPRODUCTIVE BEHAVIOR | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | FERTILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Reproduction | Population Dynamics | HIV Document Number: 330195 |
| 15. Peer Reviewed Title: Molecular phylogenetics of nearly full-length HIV type 2 envelope gene sequences from West India. Author: Jadhav S; Tripathy S; Kulkarni S; Agnihotri K; Risbud A; Paranjape R Source: AIDS Research and Human Retroviruses. 2009 Jan;25(1):115-21. Abstract: Abstract While infection with HIV-1 has become a pandemic, the presence of HIV-2 is also of concern in certain regions of the world. We have characterized the gp105 region of the envelope gene of HIV-2 isolates from Western India. Phylogenetic analysis of all 18 sequences revealed that these sequences were closely related to each other as well as to published African and European HIV-2 group A sequences, with an overall genetic divergence of 10.9% (range 2-14%). Our study sequences showed close relatedness with West African HIV-2 group A (CAM group) sequences from Guinea Bissau with 89% homology. This was further confirmed by SimPlot as well as RIP analysis. Accordingly, the sequences presented here demonstrate the predominance of HIV-2 group A infection and show no evidence of HIV-2 recombination in Western India. Language: English Keywords: INDIA | GUINEA-BISSAU | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | GENETIC TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV | GENETICS | PREVALENCE | Developing Countries | Asia, Southern | Asia | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Biology | Measurement Document Number: 330229 |
| 16. 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 |
| 17. Peer Reviewed Title: The Pediatric AIDS Corps: responding to the African HIV/AIDS health professional resource crisis. Author: Kline MW; Ferris MG; Jones DC; Calles NR; Mizwa MB; Schwarzwald HL Source: Pediatrics. 2009 Jan;123(1):134-6. Abstract: Health professional capacity for delivery of HIV/AIDS care and treatment is severely constrained across sub-Saharan Africa. African health professional expertise in pediatrics is in particularly short supply. Here we describe a Pediatric AIDS Corps program that was designed to place pediatricians and other physicians in Africa on a long-term basis to expand existing health professional capacity for pediatric and family HIV/AIDS care and treatment. In the first 2 years of this program, 76 physicians were placed in 5 African countries that have been hit hard by HIV/AIDS. Enrollment of HIV-infected children in care more than quadrupled over a 24-month period, to 26 590. We believe that this pilot program can serve as a model for larger-scale efforts to immediately expand access for African children and families to life-saving HIV/AIDS care and treatment. Language: English Keywords: AFRICA, SUB SAHARAN | EVALUATION REPORT | RECOMMENDATIONS | PILOT PROJECTS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | PHYSICIANS | HUMAN RESOURCES | CAPACITY BUILDING | HIV INFECTIONS | TREATMENT | PROGRAM DESIGN | TRAINING PROGRAMS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | Africa | Developing Countries | Evaluation | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Health Personnel | Health | Economic Factors | Program Sustainability | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Education | Program Evaluation Document Number: 328038 |
| 18. Title: Persistence of nevirapine in breast milk and plasma of mothers and their children after single-dose administration. Author: Kunz A; Frank M; Mugenyi K; Kabasinguzi R; Weidenhammer A; Kurowski M; Kloft C; Harms G Source: Journal of Antimicrobial Chemotherapy. 2009 Jan;63(1):170-7. Abstract: OBJECTIVES: Nevirapine is widely used in the developing world for the prevention of mother-to-child transmission (PMTCT) of HIV. A single mutation in the HIV genome is sufficient to lead to significant nevirapine resistance. Persistence of low-level drug concentrations in body compartments can foster resistance formation. In this study, concentration-time courses of nevirapine after single-dose administration were analysed over an extended post-partum period. PATIENTS AND METHODS: Breast milk and plasma samples of 62 HIV-positive Ugandan mother-child pairs who had received single-dose nevirapine were collected at delivery and 1, 2 and 6 weeks post-partum. Nevirapine concentrations were quantified by LC/tandem-mass-spectrometry using a quantification limit of 15 ng/mL, and a population pharmacokinetic (PK) analysis was performed. RESULTS: Concentration-time profiles in breast milk, maternal plasma and child plasma showed similar shapes. At week 1, median nevirapine concentrations were 164 ng/mL in maternal plasma, 114 ng/mL in breast milk and 183 ng/mL in child plasma. The population PK model predicted nevirapine concentrations>10 ng/mL (IC50 for nevirapine) for 13 days in breast milk, 14 days in maternal plasma and 18 days in child plasma in 80% of the samples. CONCLUSIONS: Nevirapine concentrations were present for 2-3 weeks in the three compartments. The concentrations are probably sufficiently high to protect most breastfed children from HIV transmission during the first 2 weeks. The long presence of slowly decreasing levels of nevirapine is likely to induce resistance formation. Post-natal addition of antiretrovirals for 1 week only, as recommended in the current PMTCT guidelines, will not suffice to avoid nevirapine resistance formation. Language: English Keywords: GERMANY | RESEARCH REPORT | MOTHERS | INFANT | POSTPARTUM | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | DRUGS | BREASTFEEDING | HUMAN MILK | ADMINISTRATION AND DOSAGE | TREATMENT | Europe, Central | Europe | Developed Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Nutrition | Nutrition | Lactation | Maternal Physiology | Physiology | Biology Document Number: 329752 |
| 19. Title: Increased detection of HBV DNA in HBsAg-positive and HBsAg-negative South African HIV/AIDS patients enrolling for highly active antiretroviral therapy at a Tertiary Hospital. Author: Lukhwareni A; Burnett RJ; Selabe SG; Mzileni MO; Mphahlele MJ Source: Journal of Medical Virology. 2009 Mar;81(3):406-12. Abstract: This retrospective study investigated the prevalence of hepatitis B virus (HBV) in 192 stored sera from human immunodeficiency virus (HIV) positive South African patients initiating antiretroviral therapy (ART), and explored the implications of HBV-HIV co-infection on laboratory diagnosis of HBV. HBV serology (HBsAg, anti-HBs and anti-HBc) and nested HBV PCR assays targeting the HBV polymerase gene were performed, with HBV DNA positive samples being quantified with Cobas Taqman HBV test 48 assay (Roche Diagnostics). The study found that 63% (121/192) of patients had past or present HBV infection, and 40.6% (78/192) had detectable HBV DNA. Also, 22.9% (44/192) of patients were HBsAg positive and HBV DNA positive, while 23% (34/148) of HBsAG negatives had occult HBV infections. Of the 78 HBV DNA positive samples, 62.8% had viral loads ranging from 10(2) to > or =10(8) IU/ml, and 37.2% had HBV viral loads <200 IU/ml. There was a statistically significant positive association between HBsAg-positivity and high viral loads, with 27% (12/44) of HBsAg positives having HBV viral loads between 10(4) and > or =10(8) IU/ml, compared to only 5.9% (2/34) of HBsAg negatives (relative risk: 4.64; 95% confidence interval: 1.11, 19.35; chi-square P-value = 0.015). The study shows that the majority of HIV/AIDS patients initiating ART have either acute or chronic HBV infections, and further confirms that HIV remains a risk factor for occult HBV infections in South African patients as previously shown. The findings strongly support HBV screening in all HIV-positive patients initiating ART in South Africa, considering that current ART regimens include drugs with anti-HBV activity (e.g., lamivudine). Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | GENETIC TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | HEPATITIS | ANTIRETROVIRAL THERAPY | RISK FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | HIV | Biology Document Number: 330233 |
| 20. Peer Reviewed Title: Integrating nutrition support for food-insecure patients and their dependents into an HIV care and treatment program in Western Kenya. Author: Mamlin J; Kimaiyo S; Lewis S; Tadayo H; Jerop FK; Gichunge C; Petersen T; Yih Y; Braitstein P; Einterz R Source: American Journal of Public Health. 2009 Feb;99(2):215-21. Abstract: The Academic Model Providing Access to Healthcare (AMPATH) is a partnership between Moi Teaching and Referral Hospital, Moi University School of Medicine, and a consortium of universities led by Indiana University. AMPATH has over 50,000 patients in active care in 17 main clinics around western Kenya. Despite antiretroviral therapy, many patients were not recovering their health because of food insecurity. AMPATH therefore established partnerships with the World Food Program and United States Agency for International Development and began high-production farms to complement food support. Today, nutritionists assess all AMPATH patients and dependents for food security and refer those in need to the food program. We describe the implementation, challenges, and successes of this program. Language: English Keywords: KENYA | SUMMARY REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TREATMENT | NUTRITION PROGRAMS | FOOD SECURITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Program Activities | Programs | Organization and Administration | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Primary Health Care | Food Supply | Natural Resources | Environment Document Number: 329769 |
| 21. 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 |
| 22. Title: Genetic variability of human immunodeficiency virus-1 in Bahia state, Northeast, Brazil: high diversity of HIV genotypes. Author: Monteiro JP; Alcantara LC; de Oliveira T; Oliveira AM; Melo MA; Brites C; Galvao-Castro B Source: Journal of Medical Virology. 2009 Mar;81(3):391-9. Abstract: The HIV-1 genetic variability in Bahia state, Brazil, was investigated. DNA samples from 229 and 213 HIV-1-infected individuals were analyzed using the heteroduplex mobility assay (HMA) in gag and env fragments, respectively. One hundred seventy-five samples were characterized in both genes. Thirty-two subtype F and BF recombinant viruses were sequenced and analyzed by phylogenetic methods. The combination of HMA and sequencing results showed that seven different HIV-1 genotypes comprised this sample: 147 (84%) B/B, 4 (2.3%) F/F, 3 (1.7%) B/F, 1 (0.6%) F/B, 1 (0.6%) F/D, 1 (0.6%) BF/F, and 18 (10.3%) BF/B. A significant divergence was observed between these two techniques results (84.4%). This is explained by the low accuracy of the HMA for detecting recombinant viruses. These recombinants were unrelated to CRF12, while two sequences were related to CRF28 and CRF29. Nineteen BF mosaics shared the same gag breakpoint. In conclusion, the use of HMA may be inappropriate in regions where different subtypes are co-circulating. Subtype B is the most common genotype, however, an increased prevalence (13.1%) of different BF variants and a potentially new CRF suggest that recombination is occurring frequently in Bahia. These viruses were associated with women infected heterosexually. Finally, this study identified the presence of an F/D recombinant HIV-1 in Brazil. Language: English Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | GENETIC TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | HETEROSEXUALS | PREVALENCE | HIV INFECTIONS | CHROMOSOME ABNORMALITIES | GENETICS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Economic Development | Economic Factors | Sex Behavior | Behavior | Measurement | Neonatal Diseases and Abnormalities | Biology Document Number: 330231 |
| 23. Peer Reviewed Title: Virological suppression achieved with suboptimal adherence levels among South African children receiving boosted protease inhibitor-based antiretroviral therapy. Author: Muller AD; Myer L; Jaspan H Source: Clinical Infectious Diseases. 2009 Jan 1;48(1):e3-5. Abstract: Sixty-six children who were receiving antiretroviral treatment were assessed for treatment adherence and virological outcome to compare boosted protease inhibitor-based regimens with nonnucleoside reverse-transcriptase inhibitor-based regimens. Children who were receiving protease inhibitor-based regimens demonstrated higher rates of virological suppression, even with poor treatment adherence (<80%). In children, boosted protease inhibitors seem to be more forgiving of poor adherence than do nonnucleoside reverse-transcriptase inhibitors. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | LABORATORY PROCEDURES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 329722 |
| 24. Peer Reviewed Title: Development of dual-class antiretroviral drug resistance in a child coinfected with HIV and tuberculosis: a case report from KwaZulu-Natal, South Africa. Author: Murphy RA; France H; Sunpath H; Gordon ML; Marconi VC; Kuritzkes DR; McIntosh K Source: Journal of Tropical Pediatrics. 2009 Feb;55(1):60-2. Abstract: The treatment of concurrent HIV and tuberculosis (TB) in children <3 years of age has not been well-studied and is complicated by potential drug-drug interactions. The recommended antiretroviral therapy (ART) in coinfected children in South Africa consists of full-strength ritonavir, lamivudine and stavudine. We report on a child initiated on this regimen, during concurrent TB treatment, who promptly developed an adverse reaction, virologic failure and dual-class antiretroviral drug resistance, compromising subsequent salvage ART. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | COMPLICATIONS | HIV INFECTIONS | DRUG RESISTANCE | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | DRUG INTERACTIONS | MOTHER-TO-CHILD TRANSMISSION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | HIV | Drugs | Transmission Document Number: 330401 |
| 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: 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 |
| 27. Peer Reviewed Title: A little bit pregnant: modeling how the accurate detection of pregnancy can improve HIV prevention trials. Author: Schreiber CA; Sammel M; Hillier SL; Barnhart KT Source: American Journal of Epidemiology. 2009 Feb 15;169(4):515-21. Abstract: The prevalence of unplanned pregnancies contributes to the methodological challenges of human immunodeficiency virus (HIV) prevention trials. In this paper, the authors discuss the incidence of pregnancy, including chemical pregnancy, and how the different methods of pregnancy diagnosis could affect the statistical power and calculated outcomes of HIV prevention trials. Study sample size inflation factors are estimated to aid in the design of clinical trials.The authors used published data of women attempting pregnancy as well as data from HPTN 055 (www.HPTN.org/research_studies/hptn055.asp) to estimate the percentage of early study discontinuation that would be associated with 3 diagnostic methods for pregnancy in a hypothetical clinical trial. They classified chemical pregnancies as false-positive pregnancy tests and showed the sample size adjustment that would be necessary in clinical trial design because of the early discontinuations associated with pregnancy. There is a greater than 3-fold difference in the number of falsely positive pregnancy tests that will be detected, depending upon the diagnostic method used. The number of incident pregnancies may render HIV prevention trial sample sizes inadequate by as much as 50%. Pregnancy prevention and precise pregnancy diagnosis are critical to the statistical power and integrity of HIV prevention trials. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL TRIALS | COMPARATIVE STUDIES | SAMPLING STUDIES | MATHEMATICAL MODEL | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | PREGNANCY TESTS | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | FALSE POSITIVE REACTIONS | GONADOTROPINS, CHORIONIC | Developed Countries | North America | Americas | Research Methodology | Clinical Research | Studies | Theoretical Models | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Measurement | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Disease Transmission Control | Prevention and Control | Error Sources | Gonadotropins | Hormones | Endocrine System | Physiology | Biology Document Number: 330376 |
| 28. Title: Evaluation of ocular manifestations and blindness in HIV/AIDS patients on HAART in a tertiary care hospital in western India. Author: Shah SU; Kerkar SP; Pazare AR Source: British Journal of Ophthalmology. 2009 Jan;93(1):88-90. Abstract: BACKGROUND: HIV has various ocular manifestations and with the widespread introduction of highly active antiretroviral therapy (HAART), their pattern and prevalence is expected to change. Therefore, we evaluated the HIV/AIDS patients on HAART for ocular manifestations and blindness. METHODS: In this cross-sectional study, 112 HIV-positive patients on HAART presenting to the HIV clinic with CD4 count Keywords: INDIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | BLINDNESS | TREATMENT | EVALUATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Measurement | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Ophthalmological Effects | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330210 |
| 29. Title: [Universal access, six years results in the Mexico City HIV/AIDS Program] Acceso universal al Programa de VIH/SIDA de la Ciudad de Mexico: resultados a Author: Soler Claudin C Source: Salud Publica de Mexico. 2009 Jan-Feb;51(1):26-33. Abstract: OBJECTIVE: To analyze the results of the Free Antiretroviral Medication Program of the Mexico City HIV/AIDS Program among the affected population in Mexico City. MATERIAL AND METHODS: A retrospective analysis was conducted of medical attention, antiretroviral treatment and specialized laboratory results data from 2001 to 2006 from patients who sought services from the Mexico City HIV/AIDS Program. RESULTS: Data from 5 146 patients who were undergoing ARV are presented. At the end of the period studied, 74% were current, 12.2% were not found for follow-up and 13.9% had died. CONCLUSIONS: During the period evaluated, wider coverage was achieved in Mexico City as well as increased efficiency in ARV treatment and increased patient survival. Language: Spanish Keywords: MEXICO | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HEALTH SERVICES | LABORATORY PROCEDURES | ANTIRETROVIRAL THERAPY | TREATMENT | North America | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | HIV Document Number: 330499 |
| 30. Peer Reviewed Title: The Distribution and Immune Profile of T Cell Subsets in HIV-Infected Children from Uganda. Author: Ssewanyana I; Baker CA; Ruel T; Bousheri S; Kamya M; Dorsey G; Rosenthal PJ; Charlebois E; Havlir D; Cao H Source: AIDS Research and Human Retroviruses. 2009 Jan;25(1):65-71. Abstract: Abstract T cell activation is an important mechanism in HIV-associated immune depletion. We have previously demonstrated an association between the hyperactivation of CD4(+) and CD8(+) T cells and low CD4 status in HIV-infected Ugandan children. In this study, we explore differences in activation between naive and memory T cells in HIV-infected Ugandan children. A significant correlation between CD4- and CD8-mediated immune activation and CD4 status was observed only in the memory T cells. Antiretroviral (ART) untreated and treated HIV-positive and HIV-negative children displayed similar profiles of activation and distribution within the CD4(+) naive T cells. In contrast, significantly higher immune activation of the memory CD4(+) T cell subset was seen in ART-untreated children when compared to ART-treated or HIV-negative children. ART-mediated viral suppression led to the correction of CD4(+) immune activation to levels seen in uninfected children but did not increase the size of the memory CD4(+) T cell population. High levels of CD8(+) immune activation were also found in both naive and memory cell subsets. Antiretroviral treatment led to the normalization of CD8(+) T cell activation but did not correct the distribution of naive CD8(+) T cells. We also assessed PD-1 expression on CD8(+) T cells as a measure of immune dysfunction. Upregulation of PD-1 was highest in untreated children but persisted in ART-treated children compared to uninfected children. The mechanisms of immunopathogenesis in pediatric HIV infection likely involve distinct contributions from individual naive and memory T cells subsets. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | IMMUNITY, CELLULAR | ANTIRETROVIRAL THERAPY | PREVALENCE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Family and Household | Sociocultural Factors | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | HIV | Measurement Document Number: 330230 |
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