Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author

Shi YP, Feikin DR, Marston B, Brooks JT, Poe A, Zhou Z

development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal

Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli.

HIV-positive subjects with CD4 cell count < 350 cells/muL (lower-CD4; N = 692)

received cotrimoxazole; HIV-positive with CD4 cell count > or = 350 cells/muL

(higher-CD4; N = 336) and HIV-negative subjects (N = 132) received multivitamins.

Specimens were collected at baseline, 2 weeks, monthly, and at sick visits during

6 months of follow-up to compare changes in resistance, with higher-CD4 as

referent. P. falciparum parasitemia incidence density was 16 and 156/100

person-years in lower-CD4 and higher-CD4, respectively (adjusted rate ratio [ARR] = 0.11; 95% confidence interval [CI] = 0.06-0.15; P < 0.001) and 97/100

person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44-0.86; P = 005).

Incidence density of triple and quintuple dihydrofol reductase/dihydropteroate-synthetase mutations was 90% reduced in lower-CD4 compared with referent. Overall, cotrimoxazole non-susceptibility was high among isolated pneumococcus (92%) and E. coli (76%) and increased significantly in lower-CD4 subjects by Week 2 (P < 0.005). Daily cotrimoxazole prevented malaria and reduced incidence of antifolate-resistant P. falciparum but

contributed to increased pneumococcus and commensal Escherichia coli resistance.
Language: English
Keywords: |AIDS-RELATED OPPORTUNISTIC INFECTIONS|PREVENTION & CONTROL|ADOLESCENT|ADULT|AGED|ANIMALS|ANTI-BACTERIAL AGENTS/PHARMACOLOGY|ANTI-INFECTIVE GENTS/ADMINISTRATION & DOSAGE THERAPEUTICUSE |ANTIMALARIALS/PHARMACOLOGY|COHORT STUDIES |DRUG RESISTANCE|ESCHERICHIA COLI/DRUG EFFECTS|FEMALE|HIV INFECTIONS|DRUG THERAPY|HUMANS|KENYA|MALARIA, ALCIPARUM/PARASITOLOGY/PREVENTION & CONTROL |MALE|MIDDLE AGED|PLASMODIUM FALCIPARUM/DRUG EFFECTS|PROSPECTIVE STUDIES|STREPTOCOCCUS PNEUMONIAE|DRUG EFFECTS|TRIMETHOPRIM-SULFAMETHOXAZOLE COMBINATION/ADMINISTRATION & DOSAGE| THERAPEUTIC
HIV infection does not disproportionately affect the poorer in sub-Saharan Africa.
Author: Mishra V
Source: AIDS. 2007 Nov;21 Suppl 7:S17-28.
Language: English
Abstract: Background:

Wealthier populations do better than poorer ones on most measures of

health status, including nutrition, morbidity and mortality, and healthcare

utilization.

This study examines the association between household

wealth status and HIV serostatus to identify what characteristics and behaviours

are associated with HIV infection, and the role of confounding factors such as

place of residence and other risk factors.
Methods:

Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted during 2003-2005. Dried blood spot samples were collected and tested for HIV, following internationally accepted ethical standards and laboratory procedures. The association between household wealth (measured by an index based on household ownership of durable assets and other amenities) and HIV serostatus is examined using both descriptive and multivariate statistical methods.

In all eight countries, adults in the wealthiest quintiles have a higher prevalence of HIV than those in the poorer quintiles. Prevalence increases monotonically with wealth in most cases. Similarly for cohabiting couples, the likelihood that one or both partners is HIV infected increases with wealth. The positive association between wealth and HIV prevalence is only partly explained by an association of wealth with other underlying factors, such as place of residence and education, and by differences in sexual behaviour, such as multiple sex partners, condom use, and male circumcision.

In sub-Saharan Africa, HIV prevalence does not exhibit the same

pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population.
Language: English
The impact of onset controllability on stigmatization and supportive

communication goals toward persons with HIV versus lung cancer: a comparison between Kenyan and U.S. participants.
Author: Miller AN, Fellows KL, Kizito MN
Source: Health Commun. 2007;22(3):207-19.
Abstact: This study examined the impact of controllability of onset (i.e., means of

transmission), disease type (HIV and lung cancer), and culture (Kenya and U.S.)

The pandemic of HIV/AIDS in sub-Saharan Africa and the rise of epidemics in Asia to the previously unforeseen level are likely to have global social, economic, and political impacts. In this emergency, it is vital to reappraise the weight of powerful religious and cultural factors in spreading the disease. The role of Islam in shaping values, norms, and public policies in North African states is to be appreciated for the lowest HIV prevalence in their populations. Yet, the place of religion in prevention of the disease diffusion is not fully understood nor worldwide acknowledged by the primary decision makers.

Another topic, which has received little attention to date, despite the abundance

of literature concerning the unfortunate Africa's anti-AIDS campaign, is an issue

of colonial past.
Methods:

To better comprehend the share of both traits in

diverse spread of HIV in sub-Saharan Africa, we studied the correlation between

Muslim and Christian proportions in the state's population and HIV rate.

By this method, Muslim percentage came out as a potential predictor of HIV

prevalence in a given state. In another approach, most subcontinental countries

were clustered by colocalization and similarity in their leading religion,

colonial past, and HIV seroprevalence starting from barely noticeable (0.6 - 1.2%, for Mauritania, Senegal, Somalia, and Niger) and low levels (1.9 - 4.8%, for Mali, Eritrea, Djibouti, Guinea, Guinea-Bissau, Burkina-Faso, and Chad) for Muslim populated past possessions of France and Italy, in the northern part of the subcontinent. Former territories of France, Belgium, Portugal, and the UK

formed two other groups of the countries nearing the equator with Catholic

prevailing (Democratic Republic of Congo, Republic of Congo, Rwanda, Gabon, and Burundi) or mixed populations comprising Christian, Muslim, and indigenous believers (Benin, Ghana, Uganda, Togo, Angola, Nigeria, Liberia, Kenya, Cameroon, Cote d'Ivoire, and Sierra-Leone), which covered the HIV prevalence range from 1.9% to 7%. Albeit being traced by origin to the central part of the continent, HIV has reached the highest rates in the South, particularly Malawi (14.2%), Zambia (16.5%), South Africa (21.5%), Zimbabwe (24.6%), Lesotho (28.9%), Botswana (37.3%), and Swaziland (38.8%)-all former British colonies with dominating Christian population.
Conclusion:

In the group ranking list, a distinct North to

South oriented incline in HIV rates related to prevailing religion and previous

colonial history of the country was found, endorsing the preventive role of the

Islam against rising HIV and the increased vulnerability to menace in states with

particular colonial record.

Three randomized controlled trials (RCTs) have demonstrated that male

circumcision prevents female-to-male HIV transmission in sub-Saharan Africa. Data from prospective cohort studies are helpful in considering generalizability of

RCT results to populations with unique epidemiologic/cultural characteristics.

Prospective observational cohort sub-analysis. A total of 1378 men were

evaluated after 2 years of follow-up. Baseline sociodemographic and

behavioral/HIV risk characteristics were compared between 270 uncircumcised and 1108 circumcised men. HIV incidence rates (per 100 person-years) were calculated, and Cox proportional hazards regression analyses estimated hazard rate ratios (HRs).

Of the men included in this study, 80.4% were circumcised; 73.9% were circumcised by traditional circumcisers. Circumcision was associated with tribal affiliation, high school education, fewer marriages, and smaller age difference between spouses (P < 0.05). After 2 years of follow-up, there were 30 HIV incident cases (17 in circumcised and 13 in uncircumcised men). Two-year HIV incidence rates were 0.79 (95% confidence interval [CI]: 0.46 to 1.25) for circumcised men and 2.48 (95% CI: 1.33 to 4.21) for uncircumcised men

corresponding to a HR = 0.31 (95% CI: 0.15 to 0.64). In one model controlling for

sociodemographic factors, the HR increased and became non-significant (HR = 0.55; 95% CI: 0.20 to 1.49). CONCLUSIONS: Circumcision by traditional circumcisers offers protection from HIV infection in adult men in rural Kenya. Data from well-designed prospective cohort studies in populations with unique cultural characteristics can supplement RCT data in recommending public health policy.

Insufficient data exist on the durability and tolerability of

first-line antiretroviral therapy (ART) regimens provided by HIV treatment

programs implemented in developing countries.

Longitudinal observation of clinical, immunologic, and treatment parameters of all HIV-infected adult patients initiated on ART was performed at Saint Mary's Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.

A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration was 350 days (11.6 months). Significant improvements in clinical and immunologic status were noted after 12 months of therapy. ART switches occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12 months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis treatment interactions (28.1%) were the most frequent reasons for ART switch. Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]: 1.28 to 1.98; P<0.01) and a CD4 count

Conclusions:

Excellent clinical and immunologic responses to ART were observed in

this urban Kenyan population; however, frequent switches in ART among medication classes because of toxicity or drug interactions may limit the durability of these responses.
Language: English
Keywords: |ADOLESCENT |ADULT |AGED|ANTI-RETROVIRAL AGENTS |ADVERSE EFFECTS |THERAPEUTIC USE|CD4 LYMPHOCYTE COUNT|DEVELOPING COUNTRIES|DRUG THERAPY, COMBINATION |EXANTHEMA|CHEMICALLY INDUCED|PREVENTION & CONTROL |FEMALE|GOVERNMENT PROGRAMS|TRENDS|HIV INFECTIONS |DRUG THERAPY|IMMUNOLOGY|PREVENTION & CONTROL |HUMANS |KENYA|EPIDEMIOLOGY|MALE |MIDDLE AGED|PATIENT COMPLIANCE|PERIPHERAL NERVOUS SYSTEM DISEASES|CHEMICALLY INDUCED|PREVENTION & CONTROL |PROBABILITY|SENTINEL SURVEILLANCE |TREATMENT OUTCOME |URBAN POPULATION

Understanding the differences between contrasting HIV epidemics in east and west Africa: results from a simulation model of the Four Cities Study.
Author: Orroth KK, Freeman EE, Bakker R, Buve A, Glynn JR, Boily MC, White RG, Habbema JD, Hayes RJ
Source: Sex Transm Infect. 2007 Aug;83 Suppl 1:i5-16. Epub 2007 Apr 3.
Abstract: Objective:

To determine if the differences in risk behaviours, the proportions of

males circumcised and prevalences of sexually transmitted infections (STIs)

observed in two African cities with low prevalence of HIV (Cotonou, Benin, and

Yaounde, Cameroon) and two cities with high prevalence (Kisumu, Kenya, and Ndola, Zambia) could explain the contrasting HIV epidemics in the four cities.
Methods:

An individual-based stochastic model, STDSIM, was fitted to the demographic,

behavioural and epidemiological characteristics of the four urban study

populations based on data from the Four Cities Study and other relevant sources.

Model parameters pertaining to STI and HIV natural history and transmission were held constant across the four populations. The probabilities of HIV, syphilis and chancroid acquisition were assumed to be doubled among uncircumcised males. A priori plausible ranges for model inputs and outputs were defined and sexual behaviour characteristics, including those pertaining to commercial sex workers (CSWs) and their clients, which were allowed to vary across the sites, were identified based on comparisons of the empirical data from the four sites. The proportions of males circumcised in the model, 100% in Cotonou and Yaounde, 25%in Kisumu and 10% in Ndola, were similar to those observed. A sensitivity analysis was conducted to assess how changes in critical parameters may affect the model fit.
Results:

Population characteristics observed from the study that

were replicated in the model included younger ages at sexual debut and marriage in east Africa compared with west Africa and higher numbers of casual partners in the past 12 months in Yaounde than in the other three sites. The patterns in prevalence of STIs in females in the general population and CSWs were well fitted. HIV prevalence by age and sex and time trends in prevalence in the model were consistent with study data with the highest simulated prevalences in Kisumu and Ndola, intermediate in Yaounde and lowest in Cotonou. The sensitivity analysis suggested that the effect of circumcision on the development of the HIV epidemics may have been mediated indirectly by its effect on ulcerative STI.
Conclusions:

The contrasting HIV epidemics in east and west Africa could be

replicated in our model by assuming that male circumcision reduced susceptibility to HIV, syphilis and chancroid. Varying rates of male circumcision may have played an important role in explaining the strikingly different HIV epidemics observed in different parts of sub-Saharan Africa.
Language: English
Keywords: |ADOLESCENT| ADULT|AFRICA, EASTERN |EPIDEMIOLOGY |AFRICA, WESTERN |EPIDEMIOLOGY|CIRCUMCISION, MALE |STATISTICS & NUMERICAL DATA|DISEASE OUTBREAKS |STATISTICS & NUMERICAL DATA|FEMALE|HIV INFECTIONS |EPIDEMIOLOGY|HUMANS|MALE|PREVALENCE|RISK FACTORS|RISK-TAKING|SENSITIVITY AND SPECIFICITY|SEXUAL BEHAVIOR|STATISTICS & NUMERICAL DATA|SEXUALLY TRANSMITTED DISEASES|EPIDEMIOLOGY|TRANSMISSION