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Liu X, Zhang Y, Hong Y, Zhang H. Global burden of fungal skin diseases: An update from the Global Burden of Diseases Study 2019. Mycoses 2024; 67:e13770. [PMID: 39054731 DOI: 10.1111/myc.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Fungal skin diseases are the most common and widespread fungal infections, exerting a significant impact on patients' socio-psychological health and the quality of life. OBJECTIVES To assess and compare the global burden of fungal skin diseases in 2019 and over the past 30 years. METHODS Data were retrieved from the Global Burden of Disease Study 2019. Incidence and years lived with disability (YLDs) were used to assess the burden of fungal skin diseases. A total of 204 countries and territories were hierarchically organised into 21 regions and seven super-regions. Data were presented as absolute numbers and rates per 100,000 population, stratified by sex, age, year and location. RESULTS In 2019, the global incidence rate and YLD rate of fungal skin diseases were 21,277 (95% UI 19 298-23,399) and 42 (95% UI 17-88) per 100,000 population, respectively. Sub-Saharan Africa bore the heaviest disease burden, especially children aged 5-9 years had a significantly higher incidence rate, YLD rate and YLDs to incidence ratio compared to other regions. Moreover, more than half of the incident cases among the elderly came from high-income regions and Southeast Asia, East Asia, and Oceania. Over the past 30 years, the number of incident cases and YLDs of fungal skin diseases has been continuously increasing worldwide, but the incidence rates and YLD rates have not shown significant changes. CONCLUSIONS The global burden of fungal skin diseases has been continuously rising. Children in Sub-Saharan Africa are experiencing higher disease incidence and severity compared to other regions.
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Affiliation(s)
- Xiaocong Liu
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Institute of Mycology, Jinan University, Guangzhou, Guangdong, China
| | - Yishan Zhang
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Institute of Mycology, Jinan University, Guangzhou, Guangdong, China
| | - Yujing Hong
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Institute of Mycology, Jinan University, Guangzhou, Guangdong, China
| | - Hong Zhang
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Institute of Mycology, Jinan University, Guangzhou, Guangdong, China
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Said H, Kachingwe E, Gardee Y, Bhyat Z, Ratabane J, Erasmus L, Lebaka T, van der Meulen M, Gwala T, Omar S, Ismail F, Ismail N. Determining the risk-factors for molecular clustering of drug-resistant tuberculosis in South Africa. BMC Public Health 2023; 23:2329. [PMID: 38001453 PMCID: PMC10668341 DOI: 10.1186/s12889-023-17234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) epidemic is driven mainly by the effect of ongoing transmission. In high-burden settings such as South Africa (SA), considerable demographic and geographic heterogeneity in DR-TB transmission exists. Thus, a better understanding of risk-factors for clustering can help to prioritise resources to specifically targeted high-risk groups as well as areas that contribute disproportionately to transmission. METHODS The study analyzed potential risk-factors for recent transmission in SA, using data collected from a sentinel molecular surveillance of DR-TB, by comparing demographic, clinical and epidemiologic characteristics with clustering and cluster sizes. A genotypic cluster was defined as two or more patients having identical patterns by the two genotyping methods used. Clustering was used as a proxy for recent transmission. Descriptive statistics and multinomial logistic regression were used. RESULT The study identified 277 clusters, with cluster size ranging between 2 and 259 cases. The majority (81.6%) of the clusters were small (2-5 cases) with few large (11-25 cases) and very large (≥ 26 cases) clusters identified mainly in Western Cape (WC), Eastern Cape (EC) and Mpumalanga (MP). In a multivariable model, patients in clusters including 11-25 and ≥ 26 individuals were more likely to be infected by Beijing family, have XDR-TB, living in Nelson Mandela Metro in EC or Umgungunglovo in Kwa-Zulu Natal (KZN) provinces, and having history of imprisonment. Individuals belonging in a small genotypic cluster were more likely to infected with Rifampicin resistant TB (RR-TB) and more likely to reside in Frances Baard in Northern Cape (NC). CONCLUSION Sociodemographic, clinical and bacterial risk-factors influenced rate of Mycobacterium tuberculosis (M. tuberculosis) genotypic clustering. Hence, high-risk groups and hotspot areas for clustering in EC, WC, KZN and MP should be prioritized for targeted intervention to prevent ongoing DR-TB transmission.
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Affiliation(s)
- Halima Said
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa.
| | - Elizabeth Kachingwe
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Yasmin Gardee
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Zaheda Bhyat
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - John Ratabane
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Linda Erasmus
- Centre for Enteric Diseases, National Institute of Communicable Diseases, Sandringham, Johannesburg, South Africa
| | - Tiisetso Lebaka
- Division of Surveillance and Outbreak Response, National Institute of Communicable Diseases, Sandringham, Johannesburg, South Africa
| | - Minty van der Meulen
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Thabisile Gwala
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Shaheed Omar
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Farzana Ismail
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute of Communicable Diseases, Moderfontein Road, Sandringham, Johannesburg, code 2131, South Africa
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Intestinal Parasite Infestation in HIV Infected Patients in Tertiary Care Center. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.3.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Every year, the number of people living with HIV rises as a consequence of advanced infections and the positive effects of highly active antiretroviral therapy (HAART). Gastrointestinal involvement is common, with 90% of patients seeking treatment for gastrointestinal problems as their HIV infection progresses. Nonetheless, identifying and characterization of infectious agents is important for patient management by excluding a clinical diagnosis and determining appropriate treatment, as well as determining public healthcare policy for true pathogen prevalence and yielding epidemiological risk factors for specific infections. The aim of this study is to evaluate the prevalence of symptomatic or asymptomatic intestinal parasitic infection among HIV or AIDS patients. For this study with 80 HIV seropositive patients being recruited from various wards and the Integrated Counseling and Testing Center (ICTC) affiliated to the microbiology department. Patients with acute and chronic diarrhea with abdominal disorder were taken as symptomatic whereas patients without these clinical complaints and who came for routine investigations were taken as asymptomatic. Firstly stool samples were analyzed by macroscopically for the presence of mucus, blood, larvae, segments of tapeworm and adult worms. The consistencies of stool were also recorded such as formed, watery or soft or loose with odor and color. It was examined microscopically after macroscopically for protozoan cysts and trophozoites, helminthic ova and larvae, as wet mount preparation by saline and iodine preparation as well as formal ether concentrated. For the detection of intestinal coccidian parasites, smears were prepared from stool samples and a modified Ziel-Nelseen (MZN) stain was also performed. Stool samples with the detection of parasites were informed for treatment. The prevalence of intestinal parasite was 23.75% with asymptomatic and symptomatic groups having a prevalence of 16.98% and 37.04% respectively. Out of total patients, 56.25% were male and 43.75% were female. Among the male patients, 11 (13.75%) were positive for an intestinal parasitic infection and 8 (10%) were positive among females. The age distribution data revealed that the age group 21-40 years old had the highest number of intestinal parasites, followed by 41-60, 61-80, and 0-20 years old. The most intestinal parasites were found in the young and middle-aged patients, according to this study. Different parasites were identified as Entamoeba histolytica, Taenia species, Ascaris lumbricoides, Cryptosporidium parvum and Isospora with one protozoan, two coccidian parasites and two helminthes. The most common parasite was Taenia species 6 (7.5%) followed by Entamoeba histolytica 5 (6.3%) and Cryptosporidium parvum 5 (6.3%). Intestinal parasitic infection is not uncommon in HIV seropositive patients. This study underscores the need for early diagnosis and treatment of these intestinal parasites in both symptomatic and asymptomatic HIV patients.
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Quaglio G, Pizzol D, Isaakidis P, Bortolani A, Tognon F, Marotta C, Di Gennaro F, Putoto G, Olliaro PL. Breast Tuberculosis in Women: A Systematic Review. Am J Trop Med Hyg 2020; 101:12-21. [PMID: 31115305 DOI: 10.4269/ajtmh.19-0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl-Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6-month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.
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Affiliation(s)
- Gianluca Quaglio
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy.,European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, Beira, Mozambique
| | - Petros Isaakidis
- Médecins Sans Frontières, Southern Africa Medical Unit (SAMU), Cape Town, South Africa
| | - Arianna Bortolani
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Francesca Tognon
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Piero L Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Special Programme for Research and Training in Tropical Diseases, World Health Organization (WHO/TDR), Geneva, Switzerland
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Mathema B, Andrews JR, Cohen T, Borgdorff MW, Behr M, Glynn JR, Rustomjee R, Silk BJ, Wood R. Drivers of Tuberculosis Transmission. J Infect Dis 2017; 216:S644-S653. [PMID: 29112745 PMCID: PMC5853844 DOI: 10.1093/infdis/jix354] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Measuring tuberculosis transmission is exceedingly difficult, given the remarkable variability in the timing of clinical disease after Mycobacterium tuberculosis infection; incident disease can result from either a recent (ie, weeks to months) or a remote (ie, several years to decades) infection event. Although we cannot identify with certainty the timing and location of tuberculosis transmission for individuals, approaches for estimating the individual probability of recent transmission and for estimating the fraction of tuberculosis cases due to recent transmission in populations have been developed. Data used to estimate the probable burden of recent transmission include tuberculosis case notifications in young children and trends in tuberculin skin test and interferon γ-release assays. More recently, M. tuberculosis whole-genome sequencing has been used to estimate population levels of recent transmission, identify the distribution of specific strains within communities, and decipher chains of transmission among culture-positive tuberculosis cases. The factors that drive the transmission of tuberculosis in communities depend on the burden of prevalent tuberculosis; the ways in which individuals live, work, and interact (eg, congregate settings); and the capacity of healthcare and public health systems to identify and effectively treat individuals with infectious forms of tuberculosis. Here we provide an overview of these factors, describe tools for measurement of ongoing transmission, and highlight knowledge gaps that must be addressed.
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Affiliation(s)
- Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Martien W Borgdorff
- Centers for Disease Control and Prevention, Kisumu, Kenya
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Marcel Behr
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal,Canada
| | - Judith R Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Roxana Rustomjee
- Tuberculosis Clinical Research Branch, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
| | - Benjamin J Silk
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robin Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
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Lajoie J, Mwangi L, Fowke KR. Preventing HIV infection without targeting the virus: how reducing HIV target cells at the genital tract is a new approach to HIV prevention. AIDS Res Ther 2017; 14:46. [PMID: 28893304 PMCID: PMC5594430 DOI: 10.1186/s12981-017-0166-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/11/2017] [Indexed: 01/28/2023] Open
Abstract
For over three decades, HIV infection has had a tremendous impact on the lives of individuals and public health. Microbicides and vaccines studies have shown that immune activation at the genital tract is a risk factor for HIV infection. Furthermore, lower level of immune activation, or what we call immune quiescence, has been associated with a lower risk of HIV acquisition. This unique phenotype is observed in highly-exposed seronegative individuals from different populations including female sex workers from the Pumwani cohort in Nairobi, Kenya. Here, we review the link between immune activation and susceptibility to HIV infection. We also describe a new concept in prevention where, instead of targeting the virus, we modulate the host immune system to resist HIV infection. Mimicking the immune quiescence phenotype might become a new strategy in the toolbox of biomedical methods to prevent HIV infection. Clinical trial registration on clinicaltrial.gov: #NCT02079077.
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ANN QSAR workflow for predicting the inhibition of HIV-1 reverse transcriptase by pyridinone non-nucleoside derivatives. Future Med Chem 2017; 9:1175-1191. [DOI: 10.4155/fmc-2017-0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Pyridinone derivatives have high potency against non-nucleoside reverse transcriptase inhibitor (NNRTI)-resistant human immunodeficiency virus type-1 strains. Quantitative structure–activity relationship (QSAR) studies on a series of pyridinone derivatives acting as NNRTIs are very important in designing the next generation of NNRTIs. Methodology & results: The QSAR models were developed using linear (single and forward stepwise) and combined nonlinear artificial neural network (ANN) approaches. ANN provided QSAR model with highly correlating values of 0.963, 0.964, 0.920 and 0.917, corresponding to the biological activity pIC50 of the training, validation, testing and all samples, respectively. Conclusion: The nonlinear ANN-QSAR model based on the topological polarizability, geometrical steric, hydrophobicity and substituted benzene functional group indices might be able to help for designing novel pyridinone NNRTIs.
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Campuzano S, Yáñez-Sedeño P, Pingarrón JM. Electrochemical Biosensing for the Diagnosis of Viral Infections and Tropical Diseases. ChemElectroChem 2017. [DOI: 10.1002/celc.201600805] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Susana Campuzano
- Department Analytical Chemistry; Complutense University of Madrid; Av. Complutense s/n 28040- Madrid Spain
| | - Paloma Yáñez-Sedeño
- Department Analytical Chemistry; Complutense University of Madrid; Av. Complutense s/n 28040- Madrid Spain
| | - José Manuel Pingarrón
- Department Analytical Chemistry; Complutense University of Madrid; Av. Complutense s/n 28040- Madrid Spain
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Shelton JD, Fuchs N. Opportunities and Pitfalls in Integration of Family Planning and HIV Prevention Efforts in Developing Countries. Public Health Rep 2016; 119:12-5. [PMID: 15147642 PMCID: PMC1502257 DOI: 10.1177/003335490411900104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- James D Shelton
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC 20523, USA.
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Jin C, Li J, Cheng L, Liu F, Wu N. Gp120 binding with DC-SIGN induces reactivation of HIV-1 provirus via the NF-κB signaling pathway. Acta Biochim Biophys Sin (Shanghai) 2016; 48:275-81. [PMID: 26837416 DOI: 10.1093/abbs/gmv138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/02/2015] [Indexed: 11/14/2022] Open
Abstract
The reactivation mechanism of latent human immunodeficiency virus type 1 (HIV-1) infection is unclear, especially in dendritic cells (DC). DC-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) binds with HIV-1 and other pathogens to activate the extracellular regulated protein kinase (ERK) and nuclear factor-kappa B (NF-κB) pathways and regulate cytokine expression. We hypothesized that DC-SIGN-induced signaling pathways may activate HIV-1 provirus. To investigate this hypothesis, we generated a model by transfecting 293T cells with a DC-SIGN expression plasmid and an HIV-1 5' long terminal repeat (LTR) reporter plasmid, and then stimulated the 293T cells with HIV-1 gp120 protein, wild-type HIV-1 or VSV-G-pNL4.3 pseudotype virus (without gp120 protein). It was found that the HIV-1 5'LTR was reactivated by HIV-1 gp120 in DC-SIGN-expressing 293T cells. Then the HIV-1 chronically infected CEM-Bru cells were transfected with DC-SIGN expression plasmid and stimulated by HIV-1 gp120 protein. It was found that early and late HIV-1 provirus replication was reactivated by the HIV-1 gp120/DC-SIGN stimulation. We then investigated the involvement of the ERK, p38 mitogen-activated protein kinases and NF-κB signaling pathways in HIV-1 gp120/DC-SIGN-induced activation of HIV-1 provirus by inhibiting the pathways specifically. Our results indicated that HIV-1 gp120/DC-SIGN stimulation reactivates latent HIV-1 provirus via the NF-κB signal pathway.
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Affiliation(s)
- Changzhong Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jie Li
- Department of Infectious Disease, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Linfang Cheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Fumin Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Nanping Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Abossie A, Petros B. Deworming and the immune status of HIV positive pre-antiretroviral therapy individuals in Arba Minch, Chencha and Gidole hospitals, Southern Ethiopia. BMC Res Notes 2015; 8:483. [PMID: 26415705 PMCID: PMC4585997 DOI: 10.1186/s13104-015-1461-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
Abstract
Background Helminths/HIV co-infections are very common in developing countries, especially in Africa. The effect of overlapping distribution of HIV and helminths becomes important because concomitant infection may exacerbate disease outcome of HIV infection. The study aimed at determining the effect of deworming on the immune status of helminth/HIV coinfected Pre-ART HIV patients attending three health institutions in Southern Ethiopia. Methods 97 HIV-positive Pre-ART individuals were observed into 2 groups on the basis of helminth co-infection and no infection. Out of these, 66 study participants were helminths/HIV co-infected and the remaining 31 study participants were helminths (−)/HIV (+) control. Helminth/HIV co-infected participants CD4+ T-cell count was done at baseline, after 15 weeks and 6 months after antihelminthics treatment. Data were analyzed using SPSS version 16. Results Ascaris lumbricoides was the highest prevalent soil transmitted helminths in Pre-ART individuals in this study. CD4+ T-cell count in the Ascaris lumricoides/HIV co-infected was significantly higher (P = 0.05) and (P < 0.05) after 15 weeks and 6 months post-antihelminthics treatment respectively. Also, after antihelminthic therapy, the CD4+ T-cell count significantly increased (P < 0.005) in all treated helminth infections. Conclusions The study showed that treatment of ascariasis had a significant effect on CD4+ T-cell count increase in the treated Pre-ART Ascaris lumbricoides/HIV co-infected individuals; whereas the same positive effect was not evident for other intestinal helminth parasites detected in the study. In conclusion, this finding on Ascaris lumbricoides-specific nature of immune interaction in helminth/HIV co-infection may partly explain the inconsistent reports on the role of intestinal helminths on progression of HIV infection to AIDS. Therefore, a well-designed longitudinal study on helminth species-specific HIV/helminth co-infection will be needed to fully establish the possible benefits of deworming in intestinal helminth/HIV co-infection.
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Affiliation(s)
- Ashenafi Abossie
- Medical Laboratory Technology Team, Arba Minch College of Health Sciences, P. O. Box 155, Arba Minch, Ethiopia. .,Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, P.O. Box. 1176, Addis Ababa, Ethiopia.
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, P.O. Box. 1176, Addis Ababa, Ethiopia.
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Unknown age in health disorders: A method to account for its cumulative effect and an application to feline viruses interactions. Epidemics 2015; 11:48-55. [PMID: 25979281 DOI: 10.1016/j.epidem.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 02/12/2015] [Accepted: 02/12/2015] [Indexed: 11/23/2022] Open
Abstract
Parasite interactions have been widely evidenced experimentally but field studies remain rare. Such studies are essential to detect interactions of interest and access (co)infection probabilities but face methodological obstacles. Confounding factors can create statistical associations, i.e. false parasite interactions. Among them, host age is a crucial covariate. It influences host exposition and susceptibility to many infections, and has a mechanical effect, older individuals being more at risk because of a longer exposure time. However, age is difficult to estimate in natural populations. Hence, one should be able to deal at least with its cumulative effect. Using a SI type dynamic model, we showed that the cumulative effect of age can generate false interactions theoretically (deterministic modeling) and with a real dataset of feline viruses (stochastic modeling). The risk to wrongly conclude to an association was maximal when parasites induced long-lasting antibodies and had similar forces of infection. We then proposed a method to correct for this effect (and for other potentially confounding shared risk factors) and made it available in a new R package, Interatrix. We also applied the correction to the feline viruses. It offers a way to account for an often neglected confounding factor and should help identifying parasite interactions in the field, a necessary step towards a better understanding of their mechanisms and consequences.
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13
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Rugera SP, McNerney R, Poon AK, Akimana G, Mariki RF, Kajumbula H, Kamau E, Mpawenimana S, Said SY, Toroitich A, Ronoh W, Sollis KA, Sonoiya S, Peeling RW. Regulation of medical diagnostics and medical devices in the East African community partner states. BMC Health Serv Res 2014; 14:524. [PMID: 25366990 PMCID: PMC4221680 DOI: 10.1186/s12913-014-0524-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/13/2014] [Indexed: 11/23/2022] Open
Abstract
Background Medical devices and in vitro diagnostic tests (IVD) are vital components of health delivery systems but access to these important tools is often limited in Africa. The regulation of health commodities by National Regulatory Authorities is intended to ensure their safety and quality whilst ensuring timely access to beneficial new products. Streamlining and harmonizing regulatory processes may reduce delays and unnecessary expense and improve access to new products. Whereas pharmaceutical products are widely regulated less attention has been placed on the regulation of other health products. A study was undertaken to assess regulation of medical diagnostics and medical devices across Partner States of the East African Community (EAC). Methods Data was collected during October 2012 through desk based review of documents and field research, including face to face interviews with the assistance of a structured questionnaire with closed and open ended questions. Key areas addressed were (i) existence and role of National Regulatory Authorities; (ii) policy and legal framework for regulation; (iii) premarket control; (iv) marketing controls; (v) post-marketing control and vigilance; (vi) country capacity for regulation; (vii) country capacity for evaluation studies for IVD and (viii) priorities and capacity building for harmonization in EAC Partner States. Results Control of medical devices and IVDs in EAC Partner States is largely confined to national disease programmes such as tuberculosis, HIV and malaria. National Regulatory Authorities for pharmaceutical products do not have the capacity to regulate medical devices and in some countries laboratory based organisations are mandated to ensure quality of products used. Some activities to evaluate IVDs are performed in research laboratories but post market surveillance is rare. Training in key areas is considered essential to strengthening regulatory capacity for IVDs and other medical devices. Conclusions Regulation of medical devices and in vitro diagnostics has been neglected in EAC Partner States. Regulation is weak across the region, and although the majority of States have a legal mandate to regulate medical devices there is limited capacity to do so. Streamlining regulation in the EAC is seen as a positive aspiration with diagnostic tests considered a priority area for harmonisation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0524-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon Peter Rugera
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.
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Teixeira C, Vale N, Pérez B, Gomes A, Gomes JRB, Gomes P. "Recycling" classical drugs for malaria. Chem Rev 2014; 114:11164-220. [PMID: 25329927 DOI: 10.1021/cr500123g] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Cátia Teixeira
- Centro de Investigação em Química da Universidade do Porto, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto , P-4169-007 Porto, Portugal.,CICECO, Departamento de Química, Universidade de Aveiro , P-3810-193 Aveiro, Portugal
| | - Nuno Vale
- Centro de Investigação em Química da Universidade do Porto, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto , P-4169-007 Porto, Portugal
| | - Bianca Pérez
- Centro de Investigação em Química da Universidade do Porto, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto , P-4169-007 Porto, Portugal
| | - Ana Gomes
- Centro de Investigação em Química da Universidade do Porto, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto , P-4169-007 Porto, Portugal
| | - José R B Gomes
- CICECO, Departamento de Química, Universidade de Aveiro , P-3810-193 Aveiro, Portugal
| | - Paula Gomes
- Centro de Investigação em Química da Universidade do Porto, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto , P-4169-007 Porto, Portugal
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15
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Barton HD, Rohani P, Stallknecht DE, Brown J, Drake JM. Subtype diversity and reassortment potential for co-circulating avian influenza viruses at a diversity hot spot. J Anim Ecol 2014; 83:566-75. [PMID: 24164627 PMCID: PMC4000580 DOI: 10.1111/1365-2656.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/21/2013] [Indexed: 12/25/2022]
Abstract
Biological diversity has long been used to measure ecological health. While evidence exists from many ecosystems that declines in host biodiversity may lead to greater risk of disease emergence, the role of pathogen diversity in the emergence process remains poorly understood. Particularly, because a more diverse pool of pathogen types provides more ways in which evolutionary innovations may arise, we suggest that host-pathogen systems with high pathogen diversity are more prone to disease emergence than systems with relatively homogeneous pathogen communities. We call this prediction the diversity-emergence hypothesis. To show how this hypothesis could be tested, we studied a system comprised of North American shorebirds and their associated low-pathogenicity avian influenza (LPAI) viruses. These viruses are important as a potential source of genetic innovations in influenza. A theoretical contribution of this study is an expression predicting the rate of viral subtype reassortment to be proportional to both prevalence and Simpson's Index, a formula that has been used traditionally to quantify biodiversity. We then estimated prevalence and subtype diversity in host species at Delaware Bay, a North American AIV hotspot, and used our model to extrapolate from these data. We estimated that 4 to 39 virus subtypes circulated at Delaware Bay each year between 2000 and 2008, and that surveillance coverage (percentage of co-circulating subtypes collected) at Delaware Bay is only about 63.0%. Simpson's Index in the same period varied more than fourfold from 0.22 to 0.93. These measurements together with the model provide an indirect, model-based estimate of the reassortment rate. A proper test of the diversity-emergence hypothesis would require these results to be joined to independent and reliable estimates of reassortment, perhaps obtained through molecular surveillance. These results suggest both that subtype diversity (and therefore reassortment) varies from year to year and that several subtypes contributing to reassortment are going undetected. The similarity between these results and more detailed studies of one host, ruddy turnstone (Arenaria interpres), further suggests that this species may be the primary host for influenza reassortment at Delaware Bay. Biological diversity has long been quantified using Simpson's Index. Our model links this formula to a mechanistic account of reassortment in multipathogen systems in the form of subtype diversity at Delaware Bay, USA. As a theory of how pathogen diversity may influence the evolution of novel pathogens, this work is a contribution to the larger project of understanding the connections between biodiversity and disease.
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Affiliation(s)
- Heather D Barton
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
| | - Pejman Rohani
- Department of Ecology and Evolutionary Biology and the Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI, 48109, USA
| | - David E Stallknecht
- Southeastern Cooperative Wildlife Disease Study, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Justin Brown
- Southeastern Cooperative Wildlife Disease Study, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - John M Drake
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
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Ferreira VH, Kafka JK, Kaushic C. Influence of common mucosal co-factors on HIV infection in the female genital tract. Am J Reprod Immunol 2014; 71:543-54. [PMID: 24617528 DOI: 10.1111/aji.12221] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/28/2014] [Indexed: 12/14/2022] Open
Abstract
Women constitute almost half of HIV-infected population globally, and the female genital tract (FGT) accounts for approximately 40% of all new HIV infections worldwide. The FGT is composed of upper and lower parts, distinct in their morphological and functional characteristics. Co-factors in the genital microenvironment, such as presence of hormones, semen, and other sexually transmitted infections, can facilitate or deter HIV infection and play a critical role in determining susceptibility to HIV. In this review, we examine some of these co-factors and their potential influence. Presence of physical and chemical barriers such as epithelial tight junctions, mucus, and anti-microbial peptides can actively block and inhibit viral replication, presenting a significant deterrent to HIV. Upon exposure, HIV and other pathogens first encounter the genital epithelium: cells that express a wide repertoire of pattern recognition receptors that can recognize and directly initiate innate immune responses. These and other interactions in the genital tract can lead to direct and indirect inflammation and enhance the number of local target cells, immune activation, and microbial translocation, all of which promote HIV infection and replication. Better understanding of the dynamics of HIV transmission in the female genital tract would be invaluable for improving the design of prophylactic strategies against HIV.
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Affiliation(s)
- Victor H Ferreira
- Department of Pathology and Molecular Medicine, McMaster Immunology Research Centre, Michael G. DeGroote Institute of Infectious Diseases Research, McMaster University, Hamilton, ON, Canada
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17
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Chima Anyanwu F, Ter Goon D, Tugli A, Olukoga A, O Amusa L, Netshikweta ML, Ajao B. Perception of susceptibility to the negative outcomes associated with unprotected sex among University of Venda students. Pak J Med Sci 2014; 29:1306-10. [PMID: 24550942 PMCID: PMC3905366 DOI: 10.12669/pjms.296.4111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/06/2013] [Accepted: 09/25/2013] [Indexed: 11/15/2022] Open
Abstract
Objectives: The purpose of this study was to determine the perception of University of Venda students on their susceptibility to the negative outcomes associated with unprotected sex. Methods: This cross sectional study involved 408 (206 females and 202 males) University of Venda students residing within the university campus. Simple and systematic sampling methods were used to select participants. A 4-likert scaled self-administered questionnaire was used for data collection and a cut-off point of 75% of the total scores was used as criteria for assessing perception. Results: Majority (90.90%) of the participants understood the magnitude and problems posed by HIV and other sexually transmitted infection in the society, 94.60% believe that anyone can be infected with HIV or fall pregnant when exposed to unprotected sex. Majority (87.30%) believed that alcohol consumption while engaging in sexual activities increases the chances of being infected with HIV, other STI or falling pregnant, 92.40% believed that having multiple sexual partnerships increases the risk of being infected with HIV and other sexually transmitted infections. Eighty six percent of participants agreed or strongly agreed that pregnancy could occur with one sexual intercourse in a month and only 68.45% of the participants believed that practising oral sex could expose them to HIV infection (with no significant difference between male and female). Conclusion: Majority of the students showed high perception regarding their susceptibility to the negative outcomes associated with unprotected sex, especially when they consume alcohol while engaging in sexual activities and when having multiple sexual partnerships. Contrastingly, the students demonstrated low perception regarding susceptibility to HIV transmission through the practice of oral sex. There is a need to create awareness on the dangers posed by the practise of oral sex.
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Affiliation(s)
- Felix Chima Anyanwu
- Felix Chima Anyanwu, Department of Public Health, University of Venda, Thohoyandou, South Africa
| | - Daniel Ter Goon
- Daniel Ter Goon, Centre for Biokinetics, Recreation and Sport Science, University of Venda, Thohoyandou, South Africa
| | - Augustine Tugli
- Augustine Tugli, Department of Public Health, University of Venda, Thohoyandou, South Africa
| | - Abiodun Olukoga
- Abiodun Olukoga, Department of Public Health, University of Venda, Thohoyandou, South Africa
| | - Lateef O Amusa
- Lateef O Amusa, Centre for Biokinetics, Recreation and Sport Science, University of Venda, Thohoyandou, South Africa
| | - M Lizzy Netshikweta
- Lizzy Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa
| | - Babajide Ajao
- Babajide Department of Public Health, University of Venda, Thohoyandou, South Africa
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18
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Sonntag D. Funding HIV-vaccine research in developing countries-what is wrong with IAVI's recommendation? HEALTH ECONOMICS 2014; 23:141-158. [PMID: 23355491 DOI: 10.1002/hec.2909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 09/08/2012] [Accepted: 12/20/2012] [Indexed: 06/01/2023]
Abstract
The International AIDS Vaccine Initiative recommends targeting resources to research institutions in developing countries in order to accelerate the development of an effective HIV vaccine. In contrast, this paper shows that neither lump-sum nor in-kind transfers are an effective policy. We analyze several financing mechanisms as a means to overcome the lack of depth in HIV-vaccine research in a non-cooperative framework. At first, we point to cases in which financial support is actually counterproductive. Then we analyze whether in-kind transfers are preferable to lump-sum transfers. Even if donors prefer aid in kind because the incentives for moral hazard of recipients can be reduced, we demonstrate that it is effective only if recipients have cost advantages.
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Affiliation(s)
- Diana Sonntag
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Engel RM, Morris M, Henning T, Ritter JM, Jones TL, Dietz S, Ayers J, Vishwanathan SA, Jenkins L, Zaki S, Wildemeersch D, Garber D, Powell N, Hendry RM, McNicholl J, Kersh EN. Evaluation of pigtail macaques as a model for the effects of copper intrauterine devices on HIV infection. J Med Primatol 2013; 43:349-59. [PMID: 24372425 DOI: 10.1111/jmp.12096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Long-acting, hormonal contraception may increase HIV risk. Copper intrauterine devices (IUDs) could serve as non-hormonal alternatives. We pilot a pigtail macaque model for evaluating HIV susceptibility factors during copper IUD use. METHODS Frameless and flexible GyneFix(®) copper IUDs were surgically implanted into three SHIVSF 162p3 -positive macaques via hysterotomy and monitored for up to 4 months. Four macaques served as non-IUD controls. RESULTS All animals retained the devices without complications. No consistent change in vaginal viral RNA or inflammatory cytokines was seen. Two animals had altered menstrual cycles and experienced marked thinning of vaginal epithelium after IUD insertion. Histological examination of uterine tissue at necropsy revealed endometrial ulceration and lymphocytic inflammation with glandular loss at sites of direct IUD contact. CONCLUSIONS Although the need for insertion surgery could limit its usefulness, this model will allow studies on copper IUDs and SHIV shedding, disease progression, and HIV susceptibility factors.
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Affiliation(s)
- Robyn M Engel
- Animal Resources Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
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Billo N, Castro JL, Jones S, Rusen ID, Chiang CY, Fussell M, Fujiwara PI, Harries AD, Enarson DA. The International Union Against Tuberculosis and Lung Disease: past, present and future. Int Health 2013; 1:117-23. [PMID: 24036555 DOI: 10.1016/j.inhe.2009.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The International Union Against Tuberculosis and Lung Disease (The Union) is the oldest international non-governmental organization involved in the fight against tuberculosis. This review documents the history and structure of The Union up to 2009, and describes the achievements that have taken place in the field of tuberculosis and lung health. The progress made in tackling the major killer (pneumonia) of children less than 5 years of age, the barrier to affordable essential asthma medicines, the complex issue of tobacco control, the move into the realm of HIV and AIDS, and new ideas and activities around the increasingly important domain of operational research are described and discussed. Finally, as with many institutions that have seen a rapid phase of growth, expansion and decentralisation to regional offices around the world, the review highlights the internal strategic initiative that aims to fine-tune the organisational structure, clarify lines of authority, create more efficient business, human resource and financial systems and revise, where necessary, The Union's guiding mission, vision and values for the future.
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Affiliation(s)
- Nils Billo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, 75006 Paris, France
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21
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Tian LG, Wang TP, Lv S, Wang FF, Guo J, Yin XM, Cai YC, Dickey MK, Steinmann P, Chen JX. HIV and intestinal parasite co-infections among a Chinese population: an immunological profile. Infect Dis Poverty 2013; 2:18. [PMID: 23971713 PMCID: PMC3766051 DOI: 10.1186/2049-9957-2-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/21/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Parasite infections often result in a switch of the human body's predominant immune reaction from T-helper 1 (Th1)-type to Th2-type. Hence, parasite infections are widely expected to accelerate the progression of human immunodeficiency virus (HIV) infections to acquired immunodeficiency syndrome (AIDS). In the People's Republic of China, both parasitic diseases and AIDS are epidemic in certain rural areas, and co-infections are relatively common. However, no population-based studies have yet investigated the frequency of HIV and parasite co-infections, and its effects on immune responses. We studied (1) the immune status of an HIV-infected population, and (2) the effect of co-infection of HIV and intestinal parasites on selected parameters of the human immune system. METHODS A total of 309 HIV-infected individuals were recruited and compared to an age-matched and sex-matched control group of 315 local HIV-negative individuals. Questionnaires were administered to all participants to obtain information on sociodemographic characteristics, sanitation habits, family income, and recent clinical manifestations. Two consecutive stool samples and 10 ml samples of venous blood were also collected from each individual for the diagnosis of parasite infections and quantitative measurements of selected cytokines and CD4+ T-lymphocytes, respectively. RESULTS During the study period, 79 HIV-infected individuals were not under highly active antiretroviral therapy (HAART) and were thus included in our analysis; the prevalence of intestinal helminth infections was 6.3% and that of protozoa was 22.8%. The most common protozoan infections were Blastocystis hominis (B. hominis) (13.9%) and Cryptosporidium spp. (10.1%). The prevalence of Cryptosporidium spp. in HIV-infected individuals was significantly higher than that in HIV negative individuals (P < 0.05). Compared to the non-co-infected population, no significant difference was found for any of the measured immunological indicators (P > 0.05). However, the following trends were observed: IFN-γ levels were lower, but the IL-4 level was higher, in the population co-infected with HIV and helminths. In the population co-infected with HIV and B. hominis, the IL-2 level was higher. The population co-infected with HIV and Cryptosporidium spp. had markedly lower CD4+ T-lymphocyte counts. CONCLUSION According to the immunologic profile, co-infection with helminths is disadvantageous to HIV-infected individuals. It was associated with a shift in the Th1/Th2 balance in the same direction as that caused by the virus itself, which might indicate an acceleration of the progress from an HIV infection to AIDS. Co-infection with Cryptosporidium spp. was not associated with a significant change in immune factors but co-infection with Cryptosporidium spp. was associated with a reduced level of CD4 + T-lymphocytes, confirming the opportunistic nature of such infections. Co-infection with B. hominis, on the other hand, was associated with an antagonistic shift in the immunological profile compared to an HIV infection.
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Affiliation(s)
- Li-Guang Tian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (China CDC); WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai 200025, People’s Republic of China
| | - Tian-Ping Wang
- Anhui Institute of Parasitic Disease Control, Hefei 241000, People’s Republic of China
| | - Shan Lv
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (China CDC); WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai 200025, People’s Republic of China
| | - Feng-Feng Wang
- Anhui Institute of Parasitic Disease Control, Hefei 241000, People’s Republic of China
| | - Jian Guo
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (China CDC); WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai 200025, People’s Republic of China
| | - Xiao-Mei Yin
- Anhui Institute of Parasitic Disease Control, Hefei 241000, People’s Republic of China
| | - Yu-Chun Cai
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (China CDC); WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai 200025, People’s Republic of China
| | | | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- University of Basel, Basel 4051, Switzerland
| | - Jia-Xu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (China CDC); WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai 200025, People’s Republic of China
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Intestinal parasitic infections in HIV infected and non-infected patients in a low HIV prevalence region, West-Cameroon. PLoS One 2013; 8:e57914. [PMID: 23451283 PMCID: PMC3581470 DOI: 10.1371/journal.pone.0057914] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/28/2013] [Indexed: 11/24/2022] Open
Abstract
The magnitude of intestinal parasitic infection in acquired immunodeficiency syndrome patients requires careful consideration in the developing world where poor nutrition is associated with poor hygiene and several tropical diseases. However, there have been very few studies addressing this issue in Cameroon. This study was conducted to determine the prevalence of intestinal parasitosis in HIV/AIDS patients in Dschang -Cameroon. Stool and blood specimens from HIV/AIDS patients and control group were screened respectively for intestinal parasites and for HIV antibodies. Intestinal parasites were identified using direct microscopy, formalin-ether concentration and Ziehl Neelsen methods. Out of 396 participants recruited among patients consulting at hospital, 42 (10.6%) were HIV positive, thirty of them treatment naïve. The overall prevalence of intestinal parasites was 14.64%. Out of 42 HIV/AIDS patients, 59.5% (25/42) were infected with intestinal parasites, while only 9.32% (33/354) of the HIV negative patients were infected with intestinal parasites. The parasites detected in our study population included Crystosporidium parvum (2.53%), Entamoeba histolytica (7.52%), Entamoeba coli (4.04%), Giardia lamblia (0.25%), Trichuris trichura (0.25%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%). In the HIV infected group, Crystosporidium parvum (19.04%), Entamoeba histolytica (19.04%), Entamoeba coli (21.42%), Giardia lamblia (2.38%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%) were found. Crystosporidium parvum was found to be significantly higher in HIV/AIDS patients than in controls (P<0.05). Multivariate analysis showed that the HIV status and the quality of water were the major risk factors for intestinal parasitosis. Routine examinations of stool samples for parasites would significantly benefit the HIV patients by contributing in reducing morbidity and improving the efficiency of antiretroviral treatment. Even after the introduction of free anti-retroviral drugs, opportunistic intestinal infections are still a threat. HIV patients should be screened routinely for intestinal parasites and treated for their overall well being.
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Alemu A, Shiferaw Y, Addis Z, Mathewos B, Birhan W. Effect of malaria on HIV/AIDS transmission and progression. Parasit Vectors 2013; 6:18. [PMID: 23327493 PMCID: PMC3564906 DOI: 10.1186/1756-3305-6-18] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
Malaria and HIV are among the two most important global health problems of developing countries. They cause more than 4 million deaths a year. These two infections interact bidirectionally and synergistically with each other. HIV infection increases the risk of an increase in the severity of malaria infection and burdens of malaria, which in turn facilitates the rate of malaria transmission. Malaria infection is also associated with strong CD4+ cell activation and up-regulation of proinflammatory cytokines and it provides an ideal microenvironment for the spread of the virus among the CD4+ cells and for rapid HIV-1 replication. Additionally, malaria increases blood viral burden by different mechanisms. Therefore, high concentrations of HIV-1 RNA in the blood are predictive of disease progression, and correlate with the risk of blood-borne, vertical, and sexual transmission of the virus. Therefore, this article aims to review information about HIV malaria interactions, the effect of malaria on HIV transmission and progression and the implications related to prevention and treatment of coinfection.
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Affiliation(s)
- Abebe Alemu
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yitayal Shiferaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Addis
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biniam Mathewos
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubet Birhan
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Li W, Deng G, Li M, Liu X, Wang Y. Roles of Mucosal Immunity against Mycobacterium tuberculosis Infection. Tuberc Res Treat 2012; 2012:791728. [PMID: 23213508 PMCID: PMC3504404 DOI: 10.1155/2012/791728] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 09/12/2012] [Accepted: 09/27/2012] [Indexed: 12/21/2022] Open
Abstract
Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB), is one of the world's leading infectious causes of morbidity and mortality. As a mucosal-transmitted pathogen, Mtb infects humans and animals mainly through the mucosal tissue of the respiratory tract. Apart from providing a physical barrier against the invasion of pathogen, the major function of the respiratory mucosa may be to serve as the inductive sites to initiate mucosal immune responses and sequentially provide the first line of defense for the host to defend against this pathogen. A large body of studies in the animals and humans have demonstrated that the mucosal immune system, rather than the systemic immune system, plays fundamental roles in the host's defense against Mtb infection. Therefore, the development of new vaccines and novel delivery routes capable of directly inducing respiratory mucosal immunity is emphasized for achieving enhanced protection from Mtb infection. In this paper, we outline the current state of knowledge regarding the mucosal immunity against Mtb infection, including the development of TB vaccines, and respiratory delivery routes to enhance mucosal immunity are discussed.
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Affiliation(s)
- Wu Li
- Key Laboratory of Ministry of Education for Conservation and Utilization of Special Biological Resources in the Western, Ningxia University, Yinchuan, Ningxia 750021, China
- College of Life Science, Ningxia University, 539 W. Helanshan Road, Xixia District, Yinchuan, Ningxia 750021, China
| | - Guangcun Deng
- Key Laboratory of Ministry of Education for Conservation and Utilization of Special Biological Resources in the Western, Ningxia University, Yinchuan, Ningxia 750021, China
- College of Life Science, Ningxia University, 539 W. Helanshan Road, Xixia District, Yinchuan, Ningxia 750021, China
| | - Min Li
- Key Laboratory of Ministry of Education for Conservation and Utilization of Special Biological Resources in the Western, Ningxia University, Yinchuan, Ningxia 750021, China
- College of Life Science, Ningxia University, 539 W. Helanshan Road, Xixia District, Yinchuan, Ningxia 750021, China
| | - Xiaoming Liu
- Key Laboratory of Ministry of Education for Conservation and Utilization of Special Biological Resources in the Western, Ningxia University, Yinchuan, Ningxia 750021, China
- College of Life Science, Ningxia University, 539 W. Helanshan Road, Xixia District, Yinchuan, Ningxia 750021, China
| | - Yujiong Wang
- Key Laboratory of Ministry of Education for Conservation and Utilization of Special Biological Resources in the Western, Ningxia University, Yinchuan, Ningxia 750021, China
- College of Life Science, Ningxia University, 539 W. Helanshan Road, Xixia District, Yinchuan, Ningxia 750021, China
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Auta A, Banwat S, Dayom D, Shalkur D, Avu M. Occurrence and treatment of common health problems in a nigerian community. J Young Pharm 2012; 4:49-53. [PMID: 22523461 PMCID: PMC3326783 DOI: 10.4103/0975-1483.93571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Medicines are cost-effective interventions for the treatment and management of health problems. This research was carried out to determine the common health problems and medicine-use practices in treating health problems in Lamingo, Jos, Nigeria. A total of 109 households covering 676 individuals were recruited and followed up for a period of one month between 6 November 2010 and 11 December 2010. A structured interview was conducted on weekly visits to households to identify illnesses suffered by household members and treatment given. The results showed that 146 common health problems representing 1.3 cases per household per month were found. The cost of treatment per household per month was found to be $14.7. Infectious and parasitic diseases (44.6%), diseases of the digestive (11.0%) and respiratory system (9.6%) were common in the community. Self-medication was common (34.6%) and the patent medicine stores were the most common sources of medicines. Common classes of medicines used by community members were analgesics (23.6%), antimalarials (17.9%) and antibiotics (14.2%). Factors that influenced choice of treatment were previous knowledge and experience of family members with service provider and treatment (44.4%), cost (18.9%) and severity of condition (16.7%). There is, therefore, high occurrence of health problems and self-medication practices in the Lamingo community.
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Affiliation(s)
- A Auta
- Department of Clinical Pharmacy, University of Jos, Jos, Nigeria
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Milk matters: soluble Toll-like receptor 2 (sTLR2) in breast milk significantly inhibits HIV-1 infection and inflammation. PLoS One 2012; 7:e40138. [PMID: 22792230 PMCID: PMC3391222 DOI: 10.1371/journal.pone.0040138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/01/2012] [Indexed: 11/24/2022] Open
Abstract
The majority of infants who breastfeed from their HIV-positive mothers remain uninfected despite constant and repeated exposure to virus over weeks to years. This phenomenon is not fully understood but has been closely linked to innate factors in breast milk (BM). Most recently we have focused on one such innate factor, soluble Toll-like receptor 2 (sTLR2) for its significant contribution as an inhibitor of inflammation triggered by bacterial and viral antigens. We hypothesized that sTLR2 in BM inhibits immune activation/inflammation and HIV-1 infection. sTLR2 protein profiles were analyzed in HIV-uninfected BM and showed dramatic variability in expression concentration and predominant sTLR2 forms between women. sTLR2 immunodepleted BM, versus mock-depleted BM, incubated with Pam3CSK4 lead to significant increases in IL-8 production in a TLR2-dependant fashion in U937, HEK293-TLR2, and Caco-2. Importantly, TLR2-specific polyclonal and monoclonal antibody addition to BM prior to cell-free R5 HIV-1 addition led to significantly (P<0.01, P<0.001, respectively) increased HIV-1 infection in TZM-bl reporter cells. To confirm these findings, sTLR2-depletion in BM led to significantly (P<0.001) increased HIV-1 infection in TZM-bl cells. Notably, immunodepletion does not allow for the complete removal of sTLR2 from BM, thus functional testing shown here may underestimate the total effect elicited by sTLR2 against HIV-1 and synthetic bacterial ligand. This study provides evidence for the first time that sTLR2 in BM may provide a dual protective role for infants breastfeeding from their HIV-infected mothers by; (1) immunomodulating pro-inflammatory responses to bacterial ligands, and (2) directly inhibiting cell-free HIV-1 infection. Thus, sTLR2 in BM may be critical to infant health and prove beneficial in decreasing vertical HIV-1 transmission to infants.
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Tian LG, Chen JX, Wang TP, Cheng GJ, Steinmann P, Wang FF, Cai YC, Yin XM, Guo J, Zhou L, Zhou XN. Co-infection of HIV and intestinal parasites in rural area of China. Parasit Vectors 2012; 5:36. [PMID: 22330320 PMCID: PMC3310850 DOI: 10.1186/1756-3305-5-36] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 02/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intestinal parasite infections (IPIs) are among the most significant causes of illness and disease of socially and economically disadvantaged populations in developing countries, including rural areas of the People's Republic of China. With the spread of the human immunodeficiency virus (HIV) among rural Chinese populations, there is ample scope for co-infections and there have been increasing fears about their effects. However, hardly any relevant epidemiological studies have been carried out in the country. The aim of the present survey was to assess the IPI infection status among a representative sample of HIV-positive Chinese in rural Anhui province, and compare the findings with those from a cohort of non-infected individuals. METHODS A case control study was carried out in a rural village of Fuyang, Anhui province, China. Stool samples of all participants were examined for the presence of intestinal parasites. Blood examination was performed for the HIV infection detection and anemia test. A questionnaire was administered to all study participants. RESULTS A total of 302 HIV positive and 303 HIV negative individuals provided one stool sample for examination. The overall IPI prevalence of intestinal helminth infections among HIV positives was 4.3% (13/302) while it was 5.6% (17/303) among HIV negatives, a non-significant difference. The prevalence of protozoa infections among HIV positives was 23.2% while the rate was 25.8% among HIV negatives. The species-specific prevalences among HIV positives were as follows: 3.6% for hookworm, 0.7% for Trichuris trichiura, zero for Ascaris lumbricoides, 0.3% for Clonorchis sinensis, 1.3% for Giardia intestinalis, 16.2% for Blastocystis hominis, 1.7% for Entamoeba spp. and 8.3% for Cryptosporidium spp.. Cryptosporidium spp. infections were significantly more prevalent among HIV positives (8.3%) compared to the HIV negative group (3.0%; P < 0.05). Among people infected with HIV, Cryptosporidium spp. was significantly more prevalent among males (12.6%) than females (4.4%; P < 0.05). According to multivariate logistic regression, the factors significantly associated with parasite infections of the people who were HIV positive included sex (male: OR = 6.70, 95% CI: 2.030, 22.114), younger age (less than 42 years old: OR = 4.148, 95% CI: 1.348, 12.761), and poor personal hygiene habits (OR = 0.324, 95% CI: 0.105, 0.994). CONCLUSIONS HIV positive individuals are more susceptible to co-infections with Cryptosporidium spp. than HIV negative people, particularly younger males with poor personal hygiene habits, indicating a need for targeted hygiene promotion, IPI surveillance and treatment.
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Affiliation(s)
- Li-Guang Tian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite & Vector Biology Ministry of Health, Shanghai 200025, China
| | - Jia-Xu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite & Vector Biology Ministry of Health, Shanghai 200025, China
| | - Tian-Ping Wang
- Anhui Institute of Parasitic Disease Control, Wuhu 241000, China
| | - Guo-Jin Cheng
- Fuyang Center for Disease Control and Prevention, Fuyang 236000, China
| | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland
- University of Basel, 4051 Basel, Switzerland
| | - Feng-Feng Wang
- Anhui Institute of Parasitic Disease Control, Wuhu 241000, China
| | - Yu-Chun Cai
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite & Vector Biology Ministry of Health, Shanghai 200025, China
| | - Xiao-Mei Yin
- Anhui Institute of Parasitic Disease Control, Wuhu 241000, China
| | - Jian Guo
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite & Vector Biology Ministry of Health, Shanghai 200025, China
| | - Li Zhou
- Anhui Institute of Parasitic Disease Control, Wuhu 241000, China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Key Laboratory of Parasite & Vector Biology Ministry of Health, Shanghai 200025, China
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Hellard E, Pontier D, Sauvage F, Poulet H, Fouchet D. True versus false parasite interactions: a robust method to take risk factors into account and its application to feline viruses. PLoS One 2012; 7:e29618. [PMID: 22235312 PMCID: PMC3250451 DOI: 10.1371/journal.pone.0029618] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 12/01/2011] [Indexed: 01/25/2023] Open
Abstract
Background Multiple infections are common in natural host populations and interspecific parasite interactions are therefore likely within a host individual. As they may seriously impact the circulation of certain parasites and the emergence and management of infectious diseases, their study is essential. In the field, detecting parasite interactions is rendered difficult by the fact that a large number of co-infected individuals may also be observed when two parasites share common risk factors. To correct for these “false interactions”, methods accounting for parasite risk factors must be used. Methodology/Principal Findings In the present paper we propose such a method for presence-absence data (i.e., serology). Our method enables the calculation of the expected frequencies of single and double infected individuals under the independence hypothesis, before comparing them to the observed ones using the chi-square statistic. The method is termed “the corrected chi-square.” Its robustness was compared to a pre-existing method based on logistic regression and the corrected chi-square proved to be much more robust for small sample sizes. Since the logistic regression approach is easier to implement, we propose as a rule of thumb to use the latter when the ratio between the sample size and the number of parameters is above ten. Applied to serological data for four viruses infecting cats, the approach revealed pairwise interactions between the Feline Herpesvirus, Parvovirus and Calicivirus, whereas the infection by FIV, the feline equivalent of HIV, did not modify the risk of infection by any of these viruses. Conclusions/Significance This work therefore points out possible interactions that can be further investigated in experimental conditions and, by providing a user-friendly R program and a tutorial example, offers new opportunities for animal and human epidemiologists to detect interactions of interest in the field, a crucial step in the challenge of multiple infections.
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Malarial infection among HIV patients on antiretroviral therapy (ART) and not on ART: a case study of Federal Medical Centre Makurdi, Benue State, Nigeria. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60185-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Epidemiological synergy of Trichomonas vaginalis and HIV in Zimbabwean and South African women. Sex Transm Dis 2010; 37:460-6. [PMID: 20562586 DOI: 10.1097/olq.0b013e3181cfcc4b] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trichomonas vaginalis (T. vaginalis) is the most common nonviral sexually transmitted infection in the world. Despite the coexisting global epidemics of T. vaginalis and HIV, little attention has focused on the emerging evidence that T. vaginalis increases susceptibility to, and potentially transmission of, HIV. METHODS We evaluated T. vaginalis infection in the context of a multisite, randomized controlled trial amongst women in South Africa and Zimbabwe, to determine first, if risk of HIV acquisition was increased among women recently infected with T. vaginalis, and second, if risk of T. vaginalis acquisition was increased among women infected with HIV. RESULTS After controlling for potential confounders, participants infected with T. vaginalis were more likely to test positive for HIV at their following visit, compared to participants uninfected with T. vaginalis (adjusted hazard ratio = 2.05; 95% CI, 1.05-4.02). Similarly, HIV-positive participants were twice as likely to have acquired T. vaginalis infection at the following visit, compared to HIV-negative participants (adjusted hazard ratio = 2.12; 95% CI, 1.35-3.32). CONCLUSIONS We found an increased risk of both HIV acquisition associated with T. vaginalis infection and risk of T. vaginalis acquisition associated with HIV infection. This bidirectional relationship represents a potentially important factor in sustaining the HIV epidemic in populations where T. vaginalis is endemic.
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Abdool Karim Q, Sibeko S, Baxter C. Preventing HIV infection in women: a global health imperative. Clin Infect Dis 2010; 50 Suppl 3:S122-9. [PMID: 20397940 PMCID: PMC3021824 DOI: 10.1086/651483] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Women account for approximately one-half of all human immunodeficiency virus (HIV) infections worldwide. Sexual transmission is the dominant mode of HIV transmission to women, and there is a concomitant associated epidemic of transmission to infants. The majority of HIV infections in women are in sub-Saharan Africa, with a disproportionate burden in young women <25 years of age. Acquisition and prevention of HIV infection in women is complex and influenced by biological, behavioral, and structural factors. Efforts to reduce the incidence of HIV infection among women in sub-Saharan African could play a substantial role in altering global trajectories of HIV infection. Increasing access to sexual and reproductive health services, addressing gender-based violence and social instability, reducing poverty and the need to engage in sex for survival, and encouraging greater male responsibility are critical short-to-medium-term interventions. Efforts to find a microbicide and HIV vaccine need to be matched with efforts to deepen understanding of acquisition of HIV in the female genital tract to inform development of targeted molecules for prevention of HIV infection.
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Affiliation(s)
- Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Kaushic C, Ferreira VH, Kafka JK, Nazli A. HIV infection in the female genital tract: discrete influence of the local mucosal microenvironment. Am J Reprod Immunol 2010; 63:566-75. [PMID: 20384619 DOI: 10.1111/j.1600-0897.2010.00843.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Women acquire HIV infections predominantly at the genital mucosa through heterosexual transmission. Therefore, the immune milieu at female genital surfaces is a critical determinant of HIV susceptibility. In this review, we recapitulate the evidence suggesting that several distinctive innate immune mechanisms in the female genital tract (FGT) serve to significantly deter or facilitate HIV-1 infection. Epithelial cells lining the FGT play a key role in forming a primary barrier to HIV entry. These cells express Toll-like receptors and other receptors that recognize and respond directly to pathogens, including HIV-1. In addition, innate biological factors produced by epithelial and other cells in the FGT have anti-HIV activity. Female sex hormones, co-infection with other pathogens and components in semen may also exacerbate or down-modulate HIV transmission. A combination of innate and adaptive immune factors and their interactions with the local microenvironment determine the outcome of HIV transmission. Improving our understanding of the female genital microenvironment will be useful in developing treatments that augment and sustain protective immune responses in the genital mucosa, such as microbicides and vaccines, and will provide greater insight into viral pathogenesis in the FGT.
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Affiliation(s)
- Charu Kaushic
- Center For Gene Therapeutics, Michael G. DeGroote Institute of Infectious Diseases Research, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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Ding J, Rapista A, Teleshova N, Mosoyan G, Jarvis GA, Klotman ME, Chang TL. Neisseria gonorrhoeae enhances HIV-1 infection of primary resting CD4+ T cells through TLR2 activation. THE JOURNAL OF IMMUNOLOGY 2010; 184:2814-24. [PMID: 20147631 DOI: 10.4049/jimmunol.0902125] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sexually transmitted infections increase the likelihood of HIV-1 transmission. We investigated the effect of Neisseria gonorrheae (gonococcus [GC]) exposure on HIV replication in primary resting CD4(+) T cells, a major HIV target cell during the early stage of sexual transmission of HIV. GC and TLR2 agonists, such as peptidylglycan (PGN), Pam(3)CSK(4), and Pam(3)C-Lip, a GC-derived synthetic lipopeptide, but not TLR4 agonists including LPS or GC lipooligosaccharide enhanced HIV-1 infection of primary resting CD4(+) T cells after viral entry. Pretreatment of CD4(+) cells with PGN also promoted HIV infection. Anti-TLR2 Abs abolished the HIV enhancing effect of GC and Pam(3)C-Lip, indicating that GC-mediated enhancement of HIV infection of resting CD4(+) T cells was through TLR2. IL-2 was required for TLR2-mediated HIV enhancement. PGN and GC induced cell surface expression of T cell activation markers and HIV coreceptors, CCR5 and CXCR4. The maximal postentry HIV enhancing effect was achieved when PGN was added immediately after viral exposure. Kinetic studies and analysis of HIV DNA products indicated that GC exposure and TLR2 activation enhanced HIV infection at the step of nuclear import. We conclude that GC enhanced HIV infection of primary resting CD4(+) T cells through TLR2 activation, which both increased the susceptibility of primary CD4(+) T cells to HIV infection as well as enhanced HIV-infected CD4(+) T cells at the early stage of HIV life cycle after entry. This study provides a molecular mechanism by which nonulcerative sexually transmitted infections mediate enhancement of HIV infection and has implication for HIV prevention and therapeutics.
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Affiliation(s)
- Jian Ding
- Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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Thomas BE, Dewan PK, Vijay S, Thomas A, Chauhan LS, Vedachalam C, Vaidyanathan P, Swaminathan S. Perceptions of tuberculosis patients on provider-initiated HIV testing and counseling--a study from south India. PLoS One 2009; 4:e8389. [PMID: 20041167 PMCID: PMC2791227 DOI: 10.1371/journal.pone.0008389] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/19/2009] [Indexed: 11/18/2022] Open
Abstract
Background The acceptability and feasibility of provider-initiated HIV testing and counseling (PITC) in many settings across Asia with concentrated HIV epidemics is not known. A pilot study of the PITC policy undertaken within the public health care systems in two districts in India offered the opportunity to understand patient's perspectives on the process of referral for HIV testing and linking to HIV treatment and care. Methods We conducted a cross-sectional study of randomly selected TB patients registered by the TB control program between July and November 2007 in two districts in south India. Trained interviewers met patients shortly after TB diagnosis and administered a structured questionnaire. Patients were assessed regarding their experience with HIV status assessment, referral for counseling and testing, and for HIV-infected patients the counseling itself and subsequent referral for HIV treatment and care. Results Of the 568 interviewed TB patients, 455 (80%) reported being referred for HIV testing after they presented to the health facility for investigations or treatment for TB. Over half the respondents reported having to travel long distances and incurred financial difficulties in reaching the Integrated Counselling and Testing Centre (ICTC) and two-thirds had to make more than two visits. Only 48% reported having been counseled before the test. Of the 110 HIV-infected patients interviewed, (including 43 with previously-known positive HIV status and 67 detected by PITC), 89 (81%) reported being referred for anti-retroviral treatment (ART); 82 patients reached the ART centre but only 44 had been initiated on ART. Conclusions This study provides the first evidence from India that routine, provider-initiated voluntary HIV testing of TB patients is acceptable, feasible and can be achieved with very high efficiency under programmatic conditions. While PITC is useful in identifying new HIV-infected patients so that they can be successfully linked to ART, the convenience and proximity of testing centres, quality of HIV counseling, and efficiency of ART services need attention.
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Bingenheimer JB, Geronimus AT. Behavioral mechanisms in HIV epidemiology and prevention: past, present, and future roles. Stud Fam Plann 2009; 40:187-204. [PMID: 19852409 DOI: 10.1111/j.1728-4465.2009.00202.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the 1980s, behavioral variations across geographically and socially defined populations were the central focus of AIDS research, and behavior change was seen as the primary means of controlling HIV epidemics. Today, biological mechanisms--especially other sexually transmitted infections, antiretroviral therapy, and male circumcision--predominate in HIV epidemiology and prevention. We describe several reasons for this shift in emphasis. Although the shift is understandable, we argue for a sustained focus on behavioral mechanisms in HIV research in order to realize the theoretical promise of interventions targeting the biological aspects of HIV risk. We also provide evidence to suggest that large reductions in HIV prevalence may be accomplished by small changes in behavior. Moreover, we contend that behavioral mechanisms will find their proper place in HIV epidemiology and prevention only when investigators adopt a conceptual model that treats prevalence as a determinant as well as an outcome of behavior and that explicitly recognizes the dynamic interdependence between behavior and other epidemiological and demographic parameters.
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Affiliation(s)
- Jeffrey B Bingenheimer
- Population Research Institute, Pennsylvania State University, 601 Oswald Tower, University Park, PA 16802, USA.
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Stax MJ, van Montfort T, Sprenger RR, Melchers M, Sanders RW, van Leeuwen E, Repping S, Pollakis G, Speijer D, Paxton WA. Mucin 6 in seminal plasma binds DC-SIGN and potently blocks dendritic cell mediated transfer of HIV-1 to CD4(+) T-lymphocytes. Virology 2009; 391:203-11. [PMID: 19682628 DOI: 10.1016/j.virol.2009.06.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 04/03/2009] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
Abstract
Many viruses transmitted via the genital or oral mucosa have the potential to interact with dendritic cell-specific intercellular adhesion molecule-3 grabbing non integrin (DC-SIGN) expressed on immature dendritic cells (iDCs) that lie below the mucosal surface. These cells have been postulated to capture and disseminate human immunodeficiency virus type-1 (HIV-1) to CD4(+) lymphocytes, potentially through breaches in the mucosal lining. We have previously described that BSSL (bile salt-stimulated lipase) in human milk can bind DC-SIGN and block transfer. Here we demonstrate that seminal plasma has similar DC-SIGN blocking properties as BSSL in human milk. Using comparative SDS-PAGE and Western blotting combined with mass spectrometry we identified mucin 6 as the DC-SIGN binding component in seminal plasma. Additionally, we demonstrate that purified mucin 6 binds DC-SIGN and successfully inhibits viral transfer. Mucin 6 in seminal plasma may therefore interfere with the sexual transmission of HIV-1 and other DC-SIGN co-opting viruses.
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Affiliation(s)
- Martijn J Stax
- Laboratory of Experimental Virology, Department of Medical Microbiology, Center for Infection and Immunity Amsterdam, Academic Medical Center of the University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
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Stillwaggon E. Complexity, cofactors, and the failure of AIDS policy in Africa. J Int AIDS Soc 2009; 12:12. [PMID: 19591693 PMCID: PMC2717915 DOI: 10.1186/1758-2652-12-12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 07/10/2009] [Indexed: 11/23/2022] Open
Abstract
Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy. Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, and interrupt pathways of transmission could increase the effectiveness of antiretroviral drugs and other tools of AIDS policy. In health economics, the omission of estimates of increasing returns generated by disease or treatment synergies biases cost-effectiveness analysis against multiple, yet inexpensive, interventions. Current tools of cost-effectiveness analysis only identify local maxima in a complex landscape, and can play, at best, a marginal role in the epidemic, especially where it is already generalized. Cost-effectiveness analyses for HIV that are based on the wrong epidemiological model can generate Type III errors: we get precise answers to the wrong questions about how to intervene. To control the epidemic, AIDS policy needs to utilize an epidemiological model that reflects the interactions of biological as well as behavioural variables that determine the course of HIV epidemics around the world. Cost-effectiveness analysis can benefit from using economic concepts of externalities and increasing returns to incorporate disease interactions and beneficial treatment spillovers for coinfections in HIV-prevention policy.
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Highly effective contraception and acquisition of HIV and other sexually transmitted infections. Best Pract Res Clin Obstet Gynaecol 2009; 23:263-84. [DOI: 10.1016/j.bpobgyn.2008.11.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 11/13/2008] [Accepted: 11/14/2008] [Indexed: 11/22/2022]
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Klinman DM, Klaschik S, Sato T, Tross D. CpG oligonucleotides as adjuvants for vaccines targeting infectious diseases. Adv Drug Deliv Rev 2009; 61:248-55. [PMID: 19272313 DOI: 10.1016/j.addr.2008.12.012] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2008] [Indexed: 01/14/2023]
Abstract
Synthetic oligodeoxynucleotides (ODN) containing unmethylated CpG motifs act as immune adjuvants, accelerating and boosting antigen-specific immune responses. CpG motifs promote the induction of Th1 and pro-inflammatory cytokines and support the maturation/activation of professional antigen presenting cells (particularly plasmacytoid dendritic cells). These effects are optimized by maintaining close physical contact between the CpG ODN and the immunogen. Co-administering CpG ODN with a variety of vaccines has improved the resultant humoral and/or cellular immune responses, culminating in enhanced protective immunity in rodent and primate challenge models. Ongoing clinical studies indicate that CpG ODN are safe and well-tolerated when administered as adjuvants to humans, and that they can support increased vaccine-specific immune responses.
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Affiliation(s)
- Dennis M Klinman
- Laboratory of Experimental Immunology, National Cancer Institute at Frederick, Frederick, MD 21702, United States.
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Outcome and Predictive Factors of Mortality in Hospitalized HIV-Patients in Burkina Faso. Infection 2009; 37:142-7. [DOI: 10.1007/s15010-008-7406-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 04/28/2008] [Indexed: 10/21/2022]
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Hull MW, Phillips P, Montaner JSG. Changing global epidemiology of pulmonary manifestations of HIV/AIDS. Chest 2009; 134:1287-1298. [PMID: 19059959 DOI: 10.1378/chest.08-0364] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Tremendous advances have occurred in the care of patients with HIV/AIDS resulting from the advent of highly active antiretroviral therapy (HAART). This has led to differences in the presentations of HIV-related pulmonary disease. Infections such as bacterial pneumonias, particularly Streptococcus pneumoniae, remain commonplace, while opportunistic agents such as Pneumocystis jirovecii remain a concern in patients without adequate access to optimal medical care. The tuberculosis epidemic, once thought to be slowing, has been re-energized by the spread of HIV, particularly in sub-Saharan Africa. Unusual inflammatory responses due to a phenomenon of immune reconstitution, are now recognized as a consequence of HAART, with a reported incidence of IRIS in this setting ranges from 7 to 45% in retrospective reviews. Noninfectious pulmonary conditions such as chronic obstructive lung disease and pulmonary malignancies are gaining prominence as patients are accessing antiretroviral care and enjoying significantly extended survival.
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Affiliation(s)
- Mark W Hull
- Canadian HIV Trials Network, University of British Columbia, Vancouver, BC, Canada
| | - Peter Phillips
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S G Montaner
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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DAVIES PDO. The mycobacterioses. IMAGING 2008. [DOI: 10.1259/imaging/25758678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Declines in risk behaviour and sexually transmitted infection prevalence following a community-led HIV preventive intervention among female sex workers in Mysore, India. AIDS 2008; 22 Suppl 5:S91-100. [PMID: 19098483 DOI: 10.1097/01.aids.0000343767.08197.18] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the impact on sexual behaviour and sexually transmitted infections (STI) of a comprehensive community-led intervention programme for reducing sexual risk among female sex workers (FSW) in Mysore, India. The key programme components were: community mobilization and peer-mediated outreach; increasing access to and utilization of sexual health services; and enhancing the enabling environment to support programme activities. METHODS Two cross-sectional surveys among random samples of FSW were conducted 30 months apart, in 2004 and 2006. RESULTS Of over 1000 women who sell sex in Mysore city, 429 participated in the survey at baseline and 425 at follow-up. The median age was 30 years, median duration in sex work 4 years, and the majority were street based (88%). Striking increases in condom use were seen between baseline and follow-up surveys: condom use at last sex with occasional clients was 65% versus 90%, P < 0001; with repeat clients 53% versus 66%, P < 0.001; and with regular partners 7% versus 30%, P < 0.001. STI prevalence declined from baseline to follow-up: syphilis 25% versus 12%, P < 0.001; trichomonas infection 33% versus 14%, P < 0.001; chlamydial infection 11% versus 5%, P = 0.001; gonorrhoea 5% versus 2%, P = 0.03. HIV prevalence remained stable (26% versus 24%), and detuned assay testing suggested a decline in recent HIV infections. CONCLUSION This comprehensive HIV preventive intervention empowering FSW has resulted in striking increases in reported condom use and a concomitant reduction in the prevalence of curable STI. This model should be replicated in similar urban settings across India.
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Sawers L, Stillwaggon E, Hertz T. Cofactor infections and HIV epidemics in developing countries: implications for treatment. AIDS Care 2008; 20:488-94. [PMID: 18449828 DOI: 10.1080/09540120701868311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article shows that the burden of certain tropical disease infections, after controlling for other factors, is positively correlated with HIV prevalence. Using cross-national data and multivariate linear regression analysis, we investigate the determinants of HIV prevalence in low- and middle-income countries. We begin with social and economic variables used in other cross-national studies and then incorporate data on parasitic and infectious diseases endemic in poor populations, which are found to be strongly and significantly correlated with--and are potent predictors of--HIV prevalence. The paper concludes by arguing that treating tropical diseases may be a cost-effective add-on to HIV-prevention and -treatment programs, thus slowing the spread of HIV in disease-burdened populations.
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Affiliation(s)
- L Sawers
- Department of Economics, American University, Washington, DC, USA.
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Mosam A, Hurkchand HP, Cassol E, Page T, Cassol S, Bodasing U, Aboobaker J, Dawood H, Friedland GH, Coovadia HM. Characteristics of HIV-1-associated Kaposi's sarcoma among women and men in South Africa. Int J STD AIDS 2008; 19:400-5. [PMID: 18595878 DOI: 10.1258/ijsa.2008.007301] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.
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Affiliation(s)
- A Mosam
- Department of Dermatology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Vaginal microbicide and diaphragm use for sexually transmitted infection prevention: a randomized acceptability and feasibility study among high-risk women in Madagascar. Sex Transm Dis 2008; 35:818-26. [PMID: 18562985 DOI: 10.1097/olq.0b013e318175d8ab] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In preparation for a randomized controlled trial (RCT), we conducted a pilot RCT of the acceptability and feasibility of diaphragms and candidate vaginal microbicide for sexually transmitted infection prevention among high-risk women in Madagascar. METHODS Participants were randomized to four arms: (1) diaphragm (worn continuously) with Acidform applied in the dome; (2) diaphragm (worn continuously) with placebo gel hydroxyethylcellulose (HEC) in the dome; (3) HEC applied intravaginally before sex; (4) Acidform applied intravaginally before sex. All women were given condoms. Participants were followed weekly for 4 weeks. We fit unadjusted negative binomial regression models with robust variance estimators to generate the proportion of sex acts with casual partners where condoms and experimental study products were used. RESULTS Retention was 98% among 192 participants. Experimental product use with casual partners was high, reported in 85%, 91%, 74%, and 81% of sex acts for women in the Acidform-diaphragm, HEC-diaphragm, HEC-alone, and Acidform-alone arms, respectively. However, the proportion reporting product use during 100% of acts with casual partners over the full follow-up period was much lower: 28% to 29% in the gel-diaphragm arms and 6% to 10% in gel-alone arms. Women used condoms in 62% to 67% of sex acts with casual partners, depending on the randomization arm. Participants found diaphragms easy to insert (97%) and remove (96%). Acidform users (with or without the diaphragm) reported more genitourinary symptoms than HEC users (14% vs. 5% of visits). CONCLUSIONS A sexually transmitted infection prevention RCT of candidate microbicide with and without the diaphragm appears acceptable and feasible in this population.
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Chanchaem W, Palittapongarnpim P. The significance and effect of tandem repeats within theMycobacterium tuberculosis leuAgene on α-isopropylmalate synthase. FEMS Microbiol Lett 2008; 286:166-70. [DOI: 10.1111/j.1574-6968.2008.01268.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Evidence-based planning of a randomized controlled trial on diaphragm use for prevention of sexually transmitted infections. Sex Transm Dis 2008; 35:238-42. [PMID: 18166850 DOI: 10.1097/olq.0b013e31815abaa2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We conducted formative research to evaluate the acceptability and feasibility of continuous diaphragm use among low-income women highly exposed to sexually transmitted infections (STIs) in Madagascar. GOAL To identify potential obstacles to researching the effectiveness of diaphragm use for STI prevention in a randomized controlled trial. STUDY DESIGN Mixed methods to collect complex information. In a quantitative pilot study, women were asked to use diaphragms continuously (removing once daily for cleaning) for 8 weeks and promote consistent male condom use; they were interviewed and examined clinically during follow-up. Focus group discussions (FGDs) were conducted pre-/postpilot study. Audiotaped FGDs were transcribed, translated, coded, and analyzed. RESULTS Ninety-three women participated in prepilot FGDs, 91 in the pilot study, and 82 in postpilot FGDs. Diaphragm use was acceptable and feasible, but participants reported lower condom use in FGDs than during interviews. Most participants reported in interviews that they used their diaphragms continuously, but FGDs revealed that extensive intravaginal hygiene practices may impede effective continuous diaphragm use. Despite counseling by study staff, FGDs revealed that participants believed the diaphragm provided effective protection against STIs and pregnancy. CONCLUSIONS Mixed methods formative research generated information that the prospective pilot study alone could not provide and revealed contradictory findings. Results have methodological and ethical implications that affect trial design including provision of free hormonal contraceptives, and additional instructions for vaginal hygiene to avoid displacing the diaphragm. Mixed methods formative research should be encouraged to promote evidence-based study design and implementation.
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Vidal SM, Malo D, Marquis JF, Gros P. Forward genetic dissection of immunity to infection in the mouse. Annu Rev Immunol 2008; 26:81-132. [PMID: 17953509 DOI: 10.1146/annurev.immunol.26.021607.090304] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Forward genetics is an experimental approach in which gene mapping and positional cloning are used to elucidate the molecular mechanisms underlying phenotypic differences between two individuals for a given trait. This strategy has been highly successful for the study of inbred mouse strains that show differences in innate susceptibility to bacterial, parasitic, fungal, and viral infections. Over the past 20 years, these studies have led to the identification of a number of cell populations and critical biochemical pathways and proteins that are essential for the early detection of and response to invading pathogens. Strikingly, the macrophage is the point of convergence for many of these genetic studies. This has led to the identification of diverse pathways involved in extracellular and intracellular pathogen recognition, modification of the properties and content of phagosomes, transcriptional response, and signal transduction for activation of adaptive immune mechanisms. In models of viral infections, elegant genetic studies highlighted the pivotal role of natural killer cells in the detection and destruction of infected cells.
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Affiliation(s)
- S M Vidal
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada H3G 1Y6
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Day CL, Mkhwanazi N, Reddy S, Mncube Z, van der Stok M, Klenerman P, Walker BD. Detection of polyfunctional Mycobacterium tuberculosis-specific T cells and association with viral load in HIV-1-infected persons. J Infect Dis 2008; 197:990-9. [PMID: 18419535 DOI: 10.1086/529048] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The human immunodeficiency virus type 1 (HIV-1) epidemic is associated with a significant increase in the incidence of tuberculosis (TB); however, little is known about the quality of Mycobacterium tuberculosis (MTB)-specific cellular immune responses in coinfected individuals. METHODS A total of 137 HIV-1-positive individuals in Durban, South Africa, were screened with the use of overlapping peptides spanning Ag85A, culture filtrate protein 10 (CFP-10), early secretory antigen target 6 (ESAT-6), and TB10.4, in an interferon (IFN)-gamma enzyme-linked immunospot (ELISPOT) assay. Intracellular cytokine staining for MTB-specific production of IFN-gamma, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-2 was performed, as was ex vivo phenotyping of memory markers on MTB-specific T cells. RESULTS A total of 41% of subjects responded to ESAT-6 and/or CFP-10, indicating the presence of latent MTB infection. The proportion of MTB-specific IFN-gamma(+)/TNF-alpha(+) CD4(+) cells was significantly higher than the proportion of IFN-gamma(+)/IL-2(+) CD4(+) cells (P = .0220), and the proportion of MTB-specific IL-2-secreting CD4 cells was inversely correlated with the HIV-1 load (P = .0098). MTB-specific CD8 T cells were predominately IFN-gamma(+)/TNF-alpha(+)/IL-2(-). Ex vivo memory phenotyping of MTB-specific CD4 and CD8 T cells indicated an early to intermediate differentiated phenotype for the population of effector memory cells. CONCLUSIONS Polyfunctional MTB-specific CD4 and CD8 T cell responses are maintained in the peripheral blood of HIV-1-positive individuals, in the absence of active disease, and the functional capacity of these responses is affected by HIV-1 disease status.
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Affiliation(s)
- Cheryl L Day
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu Natal, Durban, South Africa.
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