Out of control

Autoimmunity and dysmetabolism of human acquired immunodeficiency syndrome

Acquired immunodeficiency syndrome (AIDS) remains ill-defined by lists of symptoms, infections, tumors, and disorders in metabolism and immunity. Low CD4 cell count, severe loss of body weight, pneumocystis pneumonia, and Kaposi's sarcoma are the major disease indicators. Lines of evidence indicate that patients living with AIDS have both immunodeficiency and autoimmunity. Immunodeficiency is attributed to deficits in the skin- and mucosa-defined innate immunity, CD4 T cells and regulatory T cells, presumably relating human immunodeficiency virus (HIV) infection. The autoimmunity in AIDS is evident by: (1) overproduction of autoantibodies, (2) impaired response of CD4 cells and CD8 cells, (3) failure of clinical trials of HIV vaccines, and (4) therapeutic benefits of immunosuppression following solid organ transplantation and bone marrow transplantation in patients at risk of AIDS. Autoantibodies are generated in response to antigens such as debris and molecules de novo released from dead cells, infectious agents, and catabolic events. Disturbances in metabolic homeostasis occur at the interface of immunodeficiency and autoimmunity in the development of AIDS. Optimal treatments favor therapeutics targeting on the regulation of metabolism to restore immune homeostasis.

The History of the HIV/AIDS Epidemic in Africa

HIV testing of African immigrants in Belgium showed that HIV existed among Africans by 1983. However, the epidemic was recognized much later in most parts of sub-Saharan Africa (SSA) due to stigma and perceived fear of possible negative consequences to the countries' economies. This delay had devastating mortality, morbidity, and social consequences. In countries where earlier recognition occurred, political leadership was vital in mounting a response. The response involved establishment of AIDS control programs and research on the HIV epidemiology and candidate preventive interventions. Over time, the number of effective interventions has grown; the game changer being triple antiretroviral therapy (ART). ART has led to a rapid decline in HIV-related morbidity and mortality in addition to prevention of onward HIV transmission. Other effective interventions include safe male circumcision, pre-exposure prophylaxis, and post-exposure prophylaxis. However, since none of these is sufficient by itself, delivering a combination package of these interventions is important for ending the HIV epidemic as a public health threat.

Gynaecological tuberculosis since 1951

A study has been made of 711 patients with proved gynaecological tuberculosis investigated between 1 January 1951 and 31 December 1994. The main presenting symptoms in order of frequency were infertility, pelvic pain, excessive menstrual loss and amenorrhoea. The average age at first attendance was 31 years, only 16% of married women had been pregnant and palpable adnexal masses were found in 47%. Eight drug programmes were used, the best results being obtained with streptomycin, para-aminosalicyclic (PAS) acid and isoniazid or with rifampicin, ethambutol and isoniazid. Toxic drug reactions occurred in 114 patients, the drugs responsible in the majority being streptomycin and PAS. Where drug treatment failed, surgery under further drug cover was employed in 85 patients, with no deaths and no fistulae. After treatment, there were 95 pregnancies in 57 patients. In recent years there has been a rise in the incidence of tuberculosis in general in the Western world. Many factors play a part in this, by far the most important being the spread of AIDS.