Economic costs of invasive non-native species in urban areas: An underexplored financial drain

Urbanization is an important driver of global change associated with a set of environmental modifications that affect the introduction and distribution of invasive non-native species (species with populations transported by humans beyond their natural biogeographic range that established and are spreading in their introduced range; hereafter, invasive species). These species are recognized as a cause of large ecological and economic losses. Nevertheless, the economic impacts of these species in urban areas are still poorly understood. Here we present a synthesis of the reported economic costs of invasive species in urban areas using the global InvaCost database, and demonstrate that costs are likely underestimated. Sixty-one invasive species have been reported to cause a cumulative cost of US$ 326.7 billion in urban areas between 1965 and 2021 globally (average annual cost of US$ 5.7 billion). Class Insecta was responsible for >99 % of reported costs (US$ 324.4 billion), followed by Aves (US$ 1.4 billion), and Magnoliopsida (US$ 494 million). The reported costs were highly uneven with the sum of the five costliest species representing 80 % of reported costs. Most reported costs were a result of damage (77.3 %), principally impacting public and social welfare (77.9 %) and authorities-stakeholders (20.7 %), and were almost entirely in terrestrial environments (99.9 %). We found costs reported for 24 countries. Yet, there are 73 additional countries with no reported costs, but with occurrences of invasive species that have reported costs in other countries. Although covering a relatively small area of the Earth's surface, urban areas represent about 15 % of the total reported costs attributed to invasive species. These results highlight the conservative nature of the estimates and impacts, revealing important biases present in the evaluation and publication of reported data on costs. We emphasize the urgent need for more focused assessments of invasive species' economic impacts in urban areas.

Introduction pathways of economically costly invasive alien species

Introduction pathways play a pivotal role in the success of Invasive Alien Species (IAS)—the subset of alien species that have a negative environmental and/or socio-economic impact. Pathways refer to the fundamental processes that leads to the introduction of a species from one geographical location to another—marking the beginning of all alien species invasions. Increased knowledge of pathways is essential to help reduce the number of introductions and impacts of IAS and ultimately improve their management. Here we use the InvaCost database, a comprehensive repository on the global monetary impacts of IAS, combined with pathway data classified using the Convention on Biological Diversity (CBD) hierarchical classification and compiled from CABI Invasive Species Compendium, the Global Invasive Species Database (GISD) and the published literature to address five key points. Data were available for 478 individual IAS. For these, we found that both the total and annual average cost per species introduced through the ‘Stowaway’ (US$144.9bn; US$89.4m) and ‘Contaminant’ pathways (US$99.3bn; US$158.0m) were higher than species introduced primarily through the ‘Escape’ (US$87.4bn; US$25.4m) and ‘Release’ pathways (US$64.2bn; US$16.4m). Second, the recorded costs (both total and average) of species introduced unintentionally was higher than that from species introduced intentionally. Third, insects and mammals, respectively, accounted for the greatest proportion of the total cost of species introduced unintentionally and intentionally respectively, at least of the available records; ‘Stowaway’ had the highest recorded costs in Asia, Central America, North America and Diverse/Unspecified regions. Fourthly, the total cost of a species in a given location is not related to the year of first record of introduction, but time gaps might blur the true pattern. Finally, the total and average cost of IAS were not related to their number of introduction pathways. Although our findings are directly limited by the available data, they provide important material which can contribute to pathway priority measures, notably by complementing studies on pathways associated with ecologically harmful IAS. They also highlight the crucial need to fill the remaining data gaps—something that will be critical in prioritising limited management budgets to combat the current acceleration of species invasions.

Geographic and taxonomic trends of rising biological invasion costs

Invasive alien species (IAS) are a growing global ecological problem. Reports on the socio-economic impacts of biological invasions are accumulating, but our understanding of temporal trends across regions and taxa remains scarce. Accordingly, we investigated temporal trends in the economic cost of IAS and cost-reporting literature using the InvaCost database and meta-regression modelling approaches. Overall, we found that both the cost reporting literature and monetary costs increased significantly over time at the global scale, but costs increased faster than reports. Differences in global trends suggest that cost literature has accumulated most rapidly in North America and Oceania, while monetary costs have exhibited the steepest increase in Oceania, followed by Europe, Africa and North America. Moreover, the costs for certain taxonomic groups were more prominent than others and the distribution also differed spatially, reflecting a potential lack of generality in cost-causing taxa and disparate patterns of cost reporting. With regard to global trends within the Animalia and Plantae kingdoms, costs for flatworms, mammals, flowering and vascular plants significantly increased. Our results highlight significantly increasing research interest and monetary impacts of biological invasions globally, but uncover key regional differences driven by variability in reporting of costs across countries and taxa. Our findings also suggest that regions which previously had lower research effort (e.g., Africa) exhibit rapidly increasing costs, comparable to regions historically at the forefront of invasion research. While these increases may be driven by specific countries within regions, we illustrate that even after accounting for research effort (cost reporting), costs of biological invasions are rising.

Massive economic costs of biological invasions despite widespread knowledge gaps: a dual setback for India

Biological invasions are one of the top drivers of the ongoing biodiversity crisis. An underestimated consequence of invasions is the enormity of their economic impacts. Knowledge gaps regarding economic costs produced by invasive alien species (IAS) are pervasive, particularly for emerging economies such as India—the fastest growing economy worldwide. To investigate, highlight and bridge this gap, we synthesised data on the economic costs of IAS in India. Specifically, we examine how IAS costs are distributed spatially, environmentally, sectorally, taxonomically, temporally, and across introduction pathways; and discuss how Indian IAS costs vary with socioeconomic indicators. We found that IAS have cost the Indian economy between at least US$ 127.3 billion to 182.6 billion (Indian Rupees ₹ 8.3 trillion to 11.9 trillion) over 1960–2020, and these costs have increased with time. Despite these massive recorded costs, most were not assigned to specific regions, environments, sectors, cost types and causal IAS, and these knowledge gaps are more pronounced in India than in the rest of the world. When costs were specifically assigned, maximum costs were incurred in West, South and North India, by invasive alien insects in semi-aquatic ecosystems; they were incurred mainly by the public and social welfare sector, and were associated with damages and losses rather than management expenses. Our findings indicate that the reported economic costs grossly underestimate the actual costs, especially considering the expected costs given India’s population size, gross domestic product and high numbers of IAS without reported costs. This cost analysis improves our knowledge of the negative economic impacts of biological invasions in India and the burden they can represent for its development. We hope this study motivates policymakers to address socio-ecological issues in India and launch a national biological invasion research programme, especially since economic growth will be accompanied by greater impacts of global change.

Surprisingly high economic costs of biological invasions in protected areas

Biological invasions are one of the main threats to biodiversity within protected areas (PAs) worldwide. Meanwhile, the resilience of PAs to invasions remains largely unknown. Consequently, providing a better understanding of how they are impacted by invasions is critical for informing policy responses and optimally allocating resources to prevention and control strategies. Here we use the InvaCost database to address this gap from three perspectives: (i) characterizing the total reported costs of invasive alien species (IAS) in PAs; (ii) comparing mean observed costs of IAS in PAs and non-PAs; and (iii) evaluating factors affecting mean observed costs of IAS in PAs. Our results first show that, overall, the reported economic costs of IAS in PAs amounted to US$ 22.24 billion between 1975 and 2020, of which US$ 930.61 million were observed costs (already incurred) and US$ 21.31 billion were potential costs (extrapolated or predicted). Expectedly, most of the observed costs were reported for management (73%) but damages were still much higher than expected for PAs (24%); in addition, the vast majority of management costs were reported for reactive, post-invasion actions (84% of management costs, focused on eradication and control). Second, differences between costs in PAs and non-PAs varied among continents and environments. We found significantly higher IAS costs in terrestrial PA environments compared to non-PAs, while regionally, Europe incurred higher costs in PAs and Africa and Temperate Asia incurred higher costs in non-PAs. Third, characterization of drivers of IAS costs within PAs showed an effect of environments (higher costs in terrestrial environments), continents (higher in Africa and South America), taxa (higher in invertebrates and vertebrates than plants) and Human Development Index (higher in more developed countries). Globally, our findings indicate that, counterintuitively, PAs are subject to very high costs from biological invasions. This highlights the need for more resources to be invested in the management of IAS to achieve the role of PAs in ensuring the long term conservation of nature. Accordingly, more spatially-balanced and integrative studies involving both scientists and stakeholders are required.

Global costs of plant invasions must not be underestimated

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The economic costs of biological invasions in Africa: a growing but neglected threat?

Biological invasions can dramatically impact natural ecosystems and human societies. However, although knowledge of the economic impacts of biological invasions provides crucial insights for efficient management and policy, reliable syntheses are still lacking. This is particularly true for low income countries where economic resources are insufficient to control the effects of invasions. In this study, we relied on the recently developed "InvaCost" database – the most comprehensive repository on the monetised impacts of invasive alien species worldwide – to produce the first synthesis of economic costs of biological invasions on the African continent. We found that the reported costs of invasions ranged between US$ 18.2 billion and US$ 78.9 billion between 1970 and 2020. This represents a massive, yet highly underestimated economic burden for African countries. More alarmingly, these costs are exponentially increasing over time, without any signs of abatement in the near future. The reported costs were mostly driven by damage caused by invaders rather than expenses incurred for management. This trend was highly skewed towards a few regions (i.e. Southern and Eastern Africa) and activity sectors (i.e. agriculture) and incurred by a small number of invasive taxa (i.e. mainly three insect pests: Chilo partellus, Tuta absoluta, Spodoptera frugiperda). We also highlight crucial, large gaps in current knowledge on the economic costs of invasions that still need to be bridged with more widespread research effort and management actions across the continent. Finally, our study provides support for developing and implementing preventive measures as well as integrated post-invasion management actions at both national and regional levels. Considering the complex societal and economic realities in African countries, the currently neglected problem of biological invasions should become a priority for sustainable development.

Invasive alien species add to the uncertain future of protected areas

Establishing and managing protected areas (national parks, nature reserves and other sites of conservation value) represent the most common approach to conserving species and ecosystems, but these areas are vulnerable to global environmental change. Recently, Golden Kroner et al. (2019) suggested protected area downgrading, downsizing, and degazettement (PADDD) as one of the main threats to biodiversity conservation. However, there are several other elements, of similar concern, that threaten conservation efforts in protected areas, such as climate change and pollution. Here, in a commentary to the Golden Kroner et al. (2019) paper, we address an additional important element affecting protected area dynamics and robustness that was overlooked by these authors – invasions by alien species. We argue that invasive alien species (IAS) contribute directly to the pressures of biodiversity loss by competing with native species and modifying the characteristics of the invaded ecosystems, and virtually no protected areas are free from these effects. Therefore, excluding IAS from legal instruments and policy frameworks underpinning current conservation approaches in protected areas presents a great risk for nature conservation. Consequently, this aligns poorly with the idea of protected areas being a cornerstone for conservation at local, regional and national levels. For that reason and to paint a more complete picture of the effectiveness of protected areas, we argue that when other factors threatening the existence and functioning of protected areas are discussed, we also need to account for biological invasions. This will ensure that adaptive conservation management strategies protect a wide range of species, ecosystems, and landscapes. Hence, this commentary aims to be of general interest for policymakers, managers and researchers.

Invasion syndromes: a systematic approach for predicting biological invasions and facilitating effective management

Our ability to predict invasions has been hindered by the seemingly idiosyncratic context-dependency of individual invasions. However, we argue that robust and useful generalisations in invasion science can be made by considering “invasion syndromes” which we define as “a combination of pathways, alien species traits, and characteristics of the recipient ecosystem which collectively result in predictable dynamics and impacts, and that can be managed effectively using specific policy and management actions”. We describe this approach and outline examples that highlight its utility, including: cacti with clonal fragmentation in arid ecosystems; small aquatic organisms introduced through ballast water in harbours; large ranid frogs with frequent secondary transfers; piscivorous freshwater fishes in connected aquatic ecosystems; plant invasions in high-elevation areas; tall-statured grasses; and tree-feeding insects in forests with suitable hosts. We propose a systematic method for identifying and delimiting invasion syndromes. We argue that invasion syndromes can account for the context-dependency of biological invasions while incorporating insights from comparative studies. Adopting this approach will help to structure thinking, identify transferrable risk assessment and management lessons, and highlight similarities among events that were previously considered disparate invasion phenomena.

A global assessment of a large monocot family highlights the need for group-specific analyses of invasiveness

Significant progress has been made in understanding biological invasions recently, and one of the key findings is that the determinants of naturalization and invasion success vary from group to group. Here, we explore this variation for one of the largest plant families in the world, the Araceae. This group provides an excellent opportunity for identifying determinants of invasiveness in herbaceous plants, since it is one of the families most popular with horticulturalists, with species occupying various habitats and comprising many different life forms. We first developed a checklist of 3494 species of Araceae using online databases and literature sources. We aimed to determine whether invasiveness across the introduction-naturalization-invasion continuum is associated to particular traits within the family, and whether analyses focussed on specific life forms can reveal any mechanistic correlates. Boosted regression tree models were based on species invasion statuses as the response variables, and traits associated with human use, biological characteristics and distribution as the explanatory variables. The models indicate that biological traits such as plant life form and pollinator type are consistently strong correlates of invasiveness. Additionally, large-scale correlates such as the number of native floristic regions and number of introduced regions are also influential at particular stages in the invasion continuum. We used these traits to build a phenogram showing groups defined by the similarity of characters. We identified nine groups that have a greater tendency to invasiveness (includingAlocasia, the Lemnoideae andEpipremnum). From this, we propose a list of species that are not currently invasive for which we would recommend a precautionary approach to be taken. The successful management of plant invasions will depend on understanding such context-dependent effects across taxonomic groups, and across the different stages of the invasion process.

The importance of pollinators and autonomous self-fertilisation in the early stages of plant invasions: Banksia and Hakea (Proteaceae) as case studies

Reproduction is a crucial stage in the naturalisation of introduced plant species. Here, using breeding system experiments and observations of floral visitors, we investigate whether a lack of pollinators or an inability to autonomously self-fertilise limits naturalisation in five Australian Banksia species and the co-familial Hakea salicifolia in South Africa. Banksia species were heavily utilised by native insects and nectar-feeding birds. Although Banksia produced fruit when pollinators were excluded, pollinators significantly increased seed set in four of the five species. H. salicifolia flowers were visited by 11 insect species; honeybees (Apis mellifera) were the main visitors. Flowers in naturalised H. salicifolia populations received almost four times the number of visits as flowers in non-naturalised populations; the latter showed both pollen limitation (PLI 0.40) and partial self-incompatibility. This should not prevent invasion, since H. salicifolia produces fruits via autonomous selfing in the absence of pollinators. The results suggest a limited role of breeding systems in mediating naturalisation of introduced Proteaceae species. Other factors, such as features of the recipient environments, appear to be more important. Spatial variation in rates of reproduction might, however, explain variation in the extent and rate of naturalisation of different populations.

Oxidative stress and air pollution exposure during pregnancy: A molecular assessment

Chronic air pollution exposure during pregnancy can cause oxidative stress leading to adverse birth outcomes. The aim of this study was to assess and compare oxidative stress response in peripheral lymphocytes isolated from pregnant women from a highly industrialized locale (south Durban (SD); n = 50) and a control with lower air pollutant levels (north Durban (ND); n = 50). Oxidative stress response was measured by quantifying malondialdehyde (MDA) levels and a SuperArray gene panel. Mitochondrial function (adenosine triphosphate (ATP) levels and mitochondrial depolarization), DNA integrity (comet assay and mitochondrial DNA (mtDNA) viability) and DNA repair (OGG1) were assessed. Antioxidant response was assessed by quantification of glutathione (GSH) and SOD2, nuclear factor erythroid 2-related factor 2 (Nrf2) and uncoupling protein 2 (UCP2) protein and messenger RNA (mRNA) expression. Levels of MDA (p = 0.9), mitochondrial depolarization (p = 0.88), ATP (1.89-fold), SOD2 (1.23-fold) and UCP2 (1.58-fold) gene expression were elevated in the SD group with significantly higher UCP2 protein levels (p = 0.05) and longer comet tail length (p = 0.0004). The expression of Nrf2 protein (p = 0.03) and mRNA levels (-1.37-fold), GSH concentration (p < 0.0001), mtDNA amplification (-2.04-fold) and OGG1 mRNA (-2.78-fold) activity were decreased in the SD group. Of the 84 oxidative stress-related genes evaluated, 26 were differentially regulated. Pregnant women exposed to higher air pollutant levels showed increased markers for oxidative stress and compromised DNA integrity and repair.

Different traits determine introduction, naturalization and invasion success in woody plants: Proteaceae as a test case

A major aim of invasion ecology is to identify characteristics of successful invaders. However, most plant groups studied in detail (e.g. pines and acacias) have a high percentage of invasive taxa. Here we examine the global introduction history and invasion ecology of Proteaceae—a large plant family with many taxa that have been widely disseminated by humans, but with few known invaders. To do this we compiled a global list of species and used boosted regression tree models to assess which factors are important in determining the status of a species (not introduced, introduced, naturalized or invasive).

At least 402 of 1674 known species (24%) have been moved by humans out of their native ranges, 58 species (14%) have become naturalized but not invasive, and 8 species (2%) are invasive. The probability of naturalization was greatest for species with large native ranges, low susceptibility to Phytophthora root-rot fungus, large mammal-dispersed seeds, and with the capacity to resprout. The probability of naturalized species becoming invasive was greatest for species with large native ranges, those used as barrier plants, tall species, species with small seeds, and serotinous species.

The traits driving invasiveness of Proteaceae were similar to those for acacias and pines. However, while some traits showed a consistent influence at introduction, naturalization and invasion, others appear to be influential at one stage only, and some have contrasting effects at different stages. Trait-based analyses therefore need to consider different invasion stages separately. On their own, these observations provide little predictive power for risk assessment, but when the causative mechanisms are understood (e.g. Phytophthora susceptibility) they provide valuable insights. As such there is considerable value in seeking the correlates and mechanisms underlying invasions for particular taxonomic or functional groups.

A comparative study of central corneal thickness (CCT) and intraocular pressure (IOP) in University of KwaZulu-Natal students of Black and Indian ethnicity*

Thisstudy compared central corneal thickness (CCT) and intraocular pressure (IOP) of Black and Indian students from the University of Kwa-Zulu-Natal. Two hundred (100 Black and 100 Indi-an) participants of both genders aged 18-25 years (mean and standard deviation; 20.1±1.6 years) participated in this study. CCT and IOP were measured for the right eye of each participant using a Tono-Pachymeter (NT530P) and a Goldmann applanation tonometer (GAT) respectively. Data was analyzed with descriptive, t-test and Pearson’s cor-relation statistics. In the total sample (N = 200), the mean CCT value was 519.5 ± 38.6 μm and CCT was higher in the Indians (526.5 ± 37.2 µm) than in the Blacks (512.4 ± 38.9 µm) (p = 0.01).  Also, it was higher in the females (522.3 µm) than in males (516.7 µm), but the difference was insignificant (p = 0.07). The mean CCT was higher in the Indian males (520.1 µm) than in the Black males (513.2 µm), but the difference was insignificant (p=0.39).  However, it was significantly higher in the Indian females (533 µm) than in the Black females (511.6 µm) (p = 0.003). In the total sample, the mean IOP was 14.6 mmHg and IOP was greater in Indiansthan Blacks (mean = 15.3 ± 2.9 mmHg and 13.8 ± 2.6 mmHg respectively) (p = 0.01). Also, the mean IOP (N = 200) value was slightly higher in the females (14.7 mmHg) than in males (14.5 mmHg) (p = 0.51). The mean IOP was higher in the Indian males (15.0 mmHg) than in the Black males (14.0 mmHg) (p = 0.07) and the mean IOP value was higher in the Indian females (15.7 mmHg) than in the Black females (13.6 mmHg) (p < 0.001). The higher mean IOP value in the Indian than Black participants was attributed to the higher mean CCT values. A positive, but inconsistent association between CCT and IOP was found in this study, the coefficient in the total sample (r = 0.382, p = 0.000), in the Blacks (r = 0.196, p = 0.05) and in Indians (r = 0.498, p = 0.000). A national population study comparing CCT and IOP in the various South African ethnic groups is recommended. Cognizance of these differences should be taken in the diagnoses of glaucoma in these ethnic groups. (S Afr Optom 2012 71(4) 171-177)

Recommendations for the management of adult chronic myeloid leukaemia in South Africa

INTRODUCTION

Chronic myeloid leukaemia (CML) is a chronic myeloproliferative disorder characterised by a chromosomal translocation between the long arms of chromosomes 9 and 22 [corrected] resulting in the formation of the BCR-ABL fusion gene. The management of CML has undergone major changes over the past decade. Novel treatment approaches have had a dramatic impact on patient outcomes and survival. Nevertheless, these outcomes can only be achieved in the context of expert management, careful monitoring of disease response, appropriate management of adverse events and timeous adjustments to therapy when responses are not achieved within stated time-frames.

AIM

With the advent of novel treatments providing molecular responses, both the monitoring and management of CML have become more complicated. The aim of these recommendations was to provide a pragmatic yet comprehensive roadmap to negotiate these complexities.

METHODS

Recommendations were developed based on local expert opinion from both the academic and private medical care arenas after careful review of the relevant literature and taking into account the most widely used international guidelines. About five meetings were held at which these recommendations were discussed and debated in detail.

RESULTS

A comprehensive set of recommendations was compiled with an emphasis on diagnosis, investigation, treatment and monitoring of disease. Careful attention was given to circumstances unique to South Africa, funding constraints, availability and access to laboratory resources, as well as the effects of concurrent HIV infection.

CONCLUSION

Most patients with CML can live a reasonably normal life if their disease is appropriately managed. These recommendations should be of value to all specialists involved in the treatment of haematological disorders.

Cytotoxicity of a dentine bonding agent on four different cell-lines

The aim of this study was to compare the cytotoxicity of a recently available dentine bonding agent on four different cell-lines (three human dental pulp fibroblast cell-lines and one mouse 3T3 fibroblast cell-line).

METHODOLOGY

Three human dental pulp cell-lines from 3 different donors and one established 3T3 mouse cell-line were grown and sub-cultured. Cell viability following exposure to Scothbond was then compared to a similar number of controls using the MTT assay.

RESULTS

Scotchbond 1 was cytotoxic to all four cell-lines. 3T3 cells showed a survival rate of about 60% as compared to two of the human dental pulp cells which showed a significantly lower survival rate (p<0.05, Kruskal-Wallis Multiple-Comparison Test).

CONCLUSION

These findings indicated that is cytotoxic to both human pulp and 3T3 cell-lines. In general, the human pulp cell-lines showed higher sensitivity than the 3T3 cell-lines.

CLINICAL SIGNIFICANCE

Scotchbond 1 cannot be recommended for direct pulp capping techniques and care should be taken when using this dentine bonding agent in cavities where the remaining dentine layer is minimal.

Management of human immunodeficiency virus infection in pregnancy

The HIV global epidemic is having a devastating effect on women of reproductive age; women aged 15-24 years are 2.5 times more likely to be infected than young men in the same age group. Further, mother-to-child transmission (MTCT) accounts for almost two-thirds of the new infections that occur in children world-wide, annually. MTCT of HIV-1 varies widely and is dependent on obstetric practices, mode of delivery, breastfeeding, and the level of the viral load in the mother. Antiretroviral therapy (ARV) in pregnancy is prescribed for two main reasons: (i) women who need ARV medication for their own health; (ii) women who do not need treatment, or do not have access to treatment are offered prophylaxis to prevent MTCT, using one of a number of ARV regimens known to be effective. HIV infection is also associated with significant maternal morbidity and mortality. Clinicians caring for HIV-infected women need to update their knowledge continuously to provide optimal care.

Cytotoxicity of two concentrations of a dentine bonding agent on mouse 3T3 and human pulp fibroblast cell-lines

The objective of this study was to investigate the cytotoxicity and effect of concentration of a recent dentine bonding agent on a mouse fibroblast cell-line (3T3) and four different human pulp fibroblast cell-lines. A mouse fibroblast 3T3 cell-line and 4 different human pulp fibroblast cell lines were used. The cells were grown and subcultured using standard conditions. For the testing of the cytotoxicity of the bonding agent (Prime & Bond NT) it was extracted with DMEM medium and the different cell-lines were exposed to the extraction. The MTT assay was used to establish the number of viable cells. For all 5 pairs (control vs test sample) of cell-lines for 4 microl bonding agent, the mouse and only two of the four human cell-lines showed a statistical significant difference (p < 0.05; Mann-Whitney) due to the cytotoxicity of the bonding agent. However, all 5 pairs showed significant differences (p < 0.05) at the 8 microl concentration level. To investigate the relative effect of concentration (4 microl compared to 8 microl) of a chemical agent (we used a bonding agent, Prime & Bond NT) on the cytotoxicity of these 5 cell-lines, the Kruskal-Wallis Multiple-Comparison test was used on the standardised medians. Statistically significant differences (p < 0.05) were found for various cell-lines between both concentration levels. In general, the tested bonding agent, at a higher concentration level, has an increased cytotoxic effect on all 5 cell-lines. About 69% (median) of 3T3 cells stayed viable with 4 microl (0.94cm2/ml) bonding agent and 61% when 8 microl was used. For the pulp cells the percentages were between 91% and 72% for 4 microl and between 77% and 24% for 8 microl. These findings indicated that the bonding agent Prime and Bond NT was cytotoxic and that different human pulp fibroblast cell-lines should be used in the cytotoxic testing of dental materials and secondly, if only one concentration is to be used it should be in the higher range of that suggested by the ANSI/ADA document (2000, Revision) for recommended standard practices for biological evaluation of dental materials.

Vertical transmission of Mycobacterium tuberculosis in KwaZulu Natal: impact of HIV-1 co-infection

BACKGROUND

Increases in perinatal TB have paralleled the exacerbation of the TB epidemic in KwaZulu Natal. The exact risks for vertical transfer of Mycobacterium tuberculosis (VTRTB) to the baby are unknown, as is the impact of HIV-1 co-infection, which frequently accompanies maternal TB disease in the region.

DESIGN

Prospective case series study of 82 HIV-1-infected and 25 non-infected pregnant mothers, King Edward VIII Hospital, KwaZulu Natal, South Africa.

RESULTS

Perinatal mortality in HIV-1/TB diseased mothers was 85/1000 and associated with maternal anaemia (P = 0.02); 46% of newborns were premature, 66% low birth weight and 49% intrauterine growth restricted. These were significantly higher than overall hospital rates (P < 0.01, OR 4.8, 95%CI 3.2-7.0). Sites of detection of maternal TB, distribution of bacteriologically-proven TB, obstetric comorbidity and perinatal morbidity were similar in HIV-1-infected and non-infected mothers. VTRTB was detected in 16 newborns (16%), occurring similarly in bacteriologically-proven and suspected maternal TB disease, with no difference between HIV-1-infected and non-infected mothers. Eleven newborns with VTRTB were HIV-1 exposed; 64% acquired HIV-1 and died from rapidly progressive disease by 10 months of age. HIV-1-infected mothers and their exposed newborns had significantly lower CD4 counts. No association between perinatal maternal viral load, CD4 count or VTRTB was detected.

CONCLUSION

Mothers with TB disease in pregnancy are at risk for significant perinatal morbidity, mortality and VTRTB.

Dentine bonding agents--a review of adhesion to dentine

Although constant innovation has improved the performance of dentine adhesives, the true mechanism of resin adhesion to dentine is still not clear and the optimal dentinal surface pretreatment has yet to be determined for adhesive integrity of resin to dentine. The integrity of the collagen fibrils left exposed upon acid etching seem to play a major role in the mechanism of adhesion and intermingling of the adhesive monomers with the filigree of collagen fibers or hybrid layer should be considered the paramount dentine bonding mechanism. Definite trends are emerging but more research is necessary before general conclusions can be made about the functions of different bonding agents. The all-in-one self-etching/self-primer bottle systems are relatively new to the market and need more research before they can be advocated as the agent of choice.

Growth in early childhood in a cohort of children born to HIV-1-infected women from Durban, South Africa

This study describes growth in a cohort of black South African children born to HIV-1-infected women in Durban. Children born to HIV-1-seropositive women were followed up from birth to early childhood. At birth and at each visit, growth parameters were measured. Mean Z-scores were calculated for weight-for-length, weight-for-age and length-for-age and, if they were low, the children were regarded as wasted, malnourished or stunted, respectively. At the end of the study, there were 48 infected and 93 uninfected children. There were no significant differences between the two groups at birth. Thereafter, the infected group was found to have early and sustained low mean Z-scores for length-for-age and weight-for-age but not for weight-for-length. The means reached significance at ages 3, 6 and 12 months for length and at 3, 6 and 9 months for weight. Infected children who died early had more severe stunting, wasting and malnutrition than infected children who survived. Infected children born to HIV-positive women have early and sustained stunting and are malnourished but not wasted. Children with rapidly progressive disease have both stunting and wasting and are more severely affected. Early nutritional intervention might help prevent early progression or death in HIV-infected children, particularly in developing countries without access to anti-retroviral therapy in state hospitals.

Interferon-gamma and interleukin-10 production among HIV-1-infected and uninfected infants of HIV-1-infected mothers

Immunologic consequences of exposure to HIV-1 in utero are still poorly understood. This study investigates relationships between type-1 [interferon-gamma (IFN-gamma)] and type-2 (IL-10) cytokine production and maternal-infant HIV-1 transmission. Cord blood leukocytes from deliveries of 71 HIV-1-infected and 11 uninfected mothers were tested for in vitro IFN-gamma and IL-10 production after phytohemagglutinin (PHA) stimulation. The infants of these HIV-1-infected mothers were followed prospectively after birth to determine HIV vertical transmission, and IFN-gamma and IL-10 production was measured again at 6 mo. Median PHA-stimulated IFN-gamma production was 210 pg/mL in cord blood cells from infected and 73 pg/mL from uninfected mothers (p = 0.12), and median PHA-stimulated IL-10 production was 491 pg/mL in cord blood cells from infected and 161 pg/mL from uninfected mothers (p = 0.004). PHA-stimulated IFN-gamma and IL-10 production alone were not significantly associated with transmission, but relationships between the two cytokines differed among infected and uninfected infants of HIV-1-infected mothers. PHA-stimulated IFN-gamma and IL-10 production was positively correlated among infected (r = 0.7, p = 0.12 in cord blood and r = 0.66, p = 0.03 at 6 mo) but not uninfected infants, and stronger relative production of IFN-gamma to IL-10 was observed among exposed uninfected than among infected infants (p = 0.04). Exposure in utero to HIV-1 may augment production of IL-10 detectable in fetal cord blood. Stronger relative production of IFN-gamma to IL-10 in cord blood cells from infants of HIV-1-infected mothers may be associated with protection against perinatal HIV infection.

Pharmacokinetics of zidovudine and lamivudine in neonates following coadministration of oral doses every 12 hours

A phase I, repeat-dose, open-label study was conducted to determine the pharmacokinetics and safety of zidovudine and lamivudine, coadministered orally every 12 hours, in 16 neonates whose mothers were infected with human immunodeficiency virus type 1 (HIV-1). The prospective mothers had been stabilized on a zidovudine/lamivudine regimen since week 36 of pregnancy to prevent mother-to-child transmission of HIV. During 1 week postpartum, the mothers received zidovudine 300 mg plus lamivudine 150 mg every 12 hours and breastfed. Neonatal treatment was initiated 12 hours following birth with 4 mg/kg of zidovudine suspension plus 2 mg/kg of lamivudine solution every 12 hours; this regimen was continued for 1 week. Between days 1 and 7 of neonatal treatment, the neonatal oral clearance (CL/F) of zidovudine and lamivudine increased by 2-fold (p < 0.001) and 1.6-fold (p = 0.004), respectively, possibly reflecting maturation of intestinal hepatic and renal function occurring during the first week of life. Day 7/day 1 ratios for exposure (area under the serum concentration-time curve [AUC]) and maximum observed serum concentration (Cmax) were 0.48 and 0.63, respectively, for zidovudine and 0.64 and 0.73, respectively, for lamivudine. At the time of delivery, the geometric mean cord/maternal concentration ratio was 1.24 for zidovudine and 1.12 for lamivudine, indicating free passage of each drug across the placenta. The maternal and neonatal treatment regimens were well tolerated. The results of this study confirm that in the neonate, a convenient regimen combining zidovudine 4 mg/kg and lamivudine 2 mg/kg, administered orally every 12 hours, provides zidovudine serum exposure very similar to that reported with the standard neonatal zidovudine regimen of 2 mg/kg every 6 hours, as well as lamivudine serum exposure within the range reported in adults receiving lamivudine 150 mg twice a day and children receiving 4 mg/kg twice a day.

Severe, rapidly progressive human immunodeficiency virus type 1 disease in newborns with coinfections

AIM

To describe a severe form of rapidly progressive HIV-1 infection manifesting in the neonatal period.

METHOD

Prospective cohort study, King Edward VIII Hospital, Durban, South Africa. HIV-1-exposed neonates with hepatosplenomegaly, lymphadenopathy or persistent pneumonia within the first 28 days of life were investigated for perinatal infections. Confirmation of neonatal HIV-1 infection, HIV-1 subtype and clinical outcomes were studied.

RESULTS

Twenty-three (72%) of 32 symptomatic HIV-1-exposed neonates recruited at a mean of 15.2 days were HIV-1-infected. HIV-1 infection was detected in 5 patients who were tested within 48 h of birth, confirming congenital infection. Congenital infection was not excluded in any case. Median neonatal viral load at recruitment was 471,932 copies/ml and median CD4 was 777 cells/mm3. The predominant clinical presentation was growth retardation and prematurity. Perinatal infections detected included: tuberculosis (8), syphilis (6) and cytomegalovirus (10). All of the neonates with perinatal tuberculosis were HIV-1-coinfected. Maternal and neonatal viral load and CD4 at recruitment were not statistically different between the groups with tuberculosis vs. other coinfections. Gag gene sequence analysis confirmed closely aligned HIV-1 subtype C in mothers and neonates. Nineteen (83%) died by 9 months, with a mean age at death of 3.5 months.

CONCLUSIONS

A distinct group of HIV-1-infected babies may clinically manifest in the neonatal period with perinatal coinfections, subsequent rapidly progressive HIV-1 and early death.

An evaluation of on-site testing for syphilis

One of the major obstacles to the eradication of perinatal transmission of syphilis is the delay in obtaining the results of syphilis serological tests. The availability of on-site syphilis testing lead to this study which attempted to evaluate on-site syphilis testing performed by nursing staff. The seroprevalence of syphilis by laboratory rapid plasma reagin (RPR) was 8.2% (n=42). Twenty-one of the 42 women were correctly identified by the on-site test. The overall sensitivity of on-site testing was 50% [95% confidence interval (CI)=34.4-65.6]; specificity of 90.9% (95% CI=87.8-93.2). The on-site test correctly identified as uninfected 429 of the 471 women reported as RPR negative by the laboratory, giving a specificity of 91.1% (95% CI=88.1-93.4). The results of the study show that on-site RPR test had a sensitivity of 75% in respect of the clinically important titres of > or = 1:8. The specificity of the on-site test was 91.1% and on-site testing only failed to detect syphilis in those patients with titres of 1:1 and 1:2. On-site testing is a practical and cost-effective option to prevent congenital syphilis, in settings of a high prevalence of syphilis and using skilled testers.

T-helper cell responses to HIV envelope peptides in cord blood: protection against intrapartum and breast-feeding transmission

BACKGROUND

Acquired HIV-specific cell-mediated immune responses have been observed in exposed-uninfected individuals, and it has been inferred, but not demonstrated, that these responses constitute a part of natural protective immunity to HIV. This inference was tested prospectively in the natural exposure setting of maternal-infant HIV transmission in a predominantly breast-fed population.

METHODS

Cord blood from infants of HIV-seropositive women in Durban, South Africa, were tested for in vitro reactivity to a cocktail of HIV envelope peptides (Env) using a bioassay measuring interleukin-2 production in a murine cell line. Infants were followed with repeat HIV RNA tests up to 18 months of age to establish which ones acquired HIV-infection.

RESULTS

T-helper cell responses to Env were detected in 33 out of 86 (38%) cord blood samples from infants of HIV-seropositive women and in none of nine samples from seronegative women (P = 0.02). Among infants of HIV-seropositive mothers, three out of 33 with T-helper responses to Env were already infected before delivery (HIV RNA positive on the day of birth), two were lost to follow-up, and none of the others (out of 28) were found to be HIV infected on subsequent tests. In comparison, six out of 53 infants unresponsive to Env were infected before delivery, and eight out of 47 (17%) of the others were found to have acquired HIV infection intrapartum or post-partum through breast-feeding (P = 0.02).

CONCLUSIONS

T-helper cell responses to HIV envelope peptides were detected in more than one-third of newborns of HIV-infected women; no new infections were acquired by these infants at the time of delivery or post-natally through breast-feeding if these T-helper cell responses were detected in cord blood.

In vitro evaluation of two adhesive systems used with compomer filling materials

AIM

To evaluate and compare the in-vitro shear bond strength, microleakage and dentine-restorative interface of a self-etching/self-priming dentine bonding agent with a three-component dentine-bonding agent.

METHOD

For shear bond strength (SBS) testing 30 non-carious human molars were used of which 15 were tested with Non-Rinse Conditioner (NRC)/Prime&Bond NT (PBNT) and Dyract AP and 15 were tested with Scotchbond Multi-Purpose Plus (SBMP) and F2000. For the microleakage evaluation cavity preparations were made on the facial surfaces of 30 non-carious human premolars of which 15 were restored with NRC and PBNT with Dyract AP and 15 were restored with SBMP and F2000. The dentine-restorative interface was examined through a confocal scanning laser microscope (CSLM).

RESULTS

The mean SBS of PBNT and SBMP were 12.8 and 18.1 MPa, respectively. The microleakage scores showed NRC/PBNT leaked on the dentine side in 13 of the 15 specimens examined. On the enamel side two of the 15 specimens showed microleakage. With SBMP no microleakage was observed on either enamel or dentine sides. The CSLM images show clear resin tag and hybrid layer formation for both the materials examined although SBMP showed better and deeper penetration into the dentine with longer resin tags. SBMP showed resin tags measuring about 150 mm while the hybrid layer measured about 5 mm. The length of the resin tags as well as the thickness of the hybrid layer for PBNT were 20 mm Pounds and 2 mm Pounds, respectively.

CONCLUSIONS

The acid-etch technique of SBMP produced higher bond strength and no microleakage when compared with the self-etching/self-priming 'non-rinse technique' of NRC with PBNT. Thus it can only be speculated that SBMP should be the superior in the clinical situation.

Tissue kallikrein and kinins in renal disease

The renal kallikrein-kinin system is involved in sodium and water homeostasis, blood pressure regulation and inflammation. Tissue kallikrein and kinin levels were measured in the urine of patients with renal disease and in the urine of living related kidney donors prior to uninephrectomy who served as controls. Tissue kallikrein and kinin B1 and B2 receptors were immunolocalised by confocal microscopy in renal biopsy material from patients with renal disease and controls (fresh autopsy material and normal kidney tissue from nephrectomies for malignancy). Urinary tissue kallikrein excretion was significantly decreased in patients with mild renal disease (16.6 +/- 6.7 ng tissue kallikrein (TK)/ng protein; p < 0.05) and more markedly so (1.8 +/- 0.7 ng TK/microg protein; p < 0.01) in patients with severe renal failure requiring dialysis compared to normal controls (78.9 +/- 31.7 ng TK/microg protein). Basal kinin values were unchanged in patients with renal disease (14 +/- 0.8 ng/ml) compared to controls (13.3 +/- 0.56 ng/ml). In control kidney tissue kallikrein was immunolocalised in the distal connecting tubules and collecting ducts whereas decreased immunolabelling was observed with renal disease. Kinin B2 receptor labelling was present in the entire nephron in the normal control kidney but was reduced with renal disease. While kinin B1 receptor immunolabelling was not observed in the control kidneys, labelling of distal tubules and collecting ducts was noted in renal disease, suggesting an upregulation of B1 receptors in renal parenchymal disease.

Mortality in a cohort of children born to HIV-1 infected women from Durban, South Africa

OBJECTIVES

To describe mortality in a cohort of infants with vertically transmitted HIV-1 infection.

PATIENTS AND METHODS

Children of HIV-1 infected women were followed up from birth and a record was made at each visit of growth, development and all illnesses. Details surrounding death were obtained from hospital records.

RESULTS

The final cohort comprised 48 infected and 93 uninfected children; there were 25 deaths, 17 of which (35%) were regarded as being HIV-related. The mean age at death of HIV-related cases was 10.1 months (range 1-48 months), with 83% of HIV-related deaths occurring before the age of 10 months. The commonest diagnoses at the time of death were diarrhoea, pneumonia, failure to thrive and severe thrush. These findings, together with neurological abnormalities, often presaged rapid deterioration and death.

CONCLUSIONS

Mortality among children with vertically acquired HIV infection is high in the first year of life. Death in these subjects was due to the common causes of morbidity and mortality among all children in developing countries. A combination of diarrhoea, pneumonia, failure to thrive, and neurological abnormalities should alert one to the possibility of rapidly progressive disease and death.

HIV type 1 V3 domain serotyping and genotyping in Gauteng, Mpumalanga, KwaZulu-Natal, and Western Cape Provinces of South Africa

More than 20.8 million people are living with HIV/AIDS in sub-Saharan Africa, with southern Africa the worst affected area and accounting for one of the fastest growing AIDS epidemics worldwide. Samples from 81 patients, including 25 from KwaZulu-Natal, 26 from Gauteng, 5 from Mpumalanga, and 25 from Western Cape Province, were serotyped using a competitive V3 peptide enzyme immunoassay (cPEIA). Viral RNA was also isolated from serum and the V3 region amplified by reverse transcriptase polymerase chain reaction (RT-PCR) to obtain a 240-bp product for direct sequencing of 29 samples. CLUSTAL W was used to make multiple sequence alignments. Distance calculation, tree construction methods, and bootstrap analysis were done using TREECON. Subtype C-like V3 loop sequences predominate in all provinces tested in South Africa. Discordant sero- and genotype results were observed in one patient only. The correlation between sero- and genotyping was 96% (24 of 25) in KwaZulu-Natal and 100% in Gauteng and Mpumalanga. In Western Cape Province 18% of patients were identified as sero/genotype B and 82% as sero/genotype C. Our data show that results of the second-generation V3 cPEIA correlated well with V3 sequencing and would be a rapid and affordable screening test to monitor the explosive southern African HIV-1 epidemic.

Pharmacokinetics and antiretroviral activity of lamivudine alone or when coadministered with zidovudine in human immunodeficiency virus type 1-infected pregnant women and their offspring

The safety, pharmacokinetics, and antiretroviral activity of lamivudine alone and in combination with zidovudine was studied in pregnant women infected with human immunodeficiency virus type 1 (HIV-1) and their neonates. Women received the drugs orally from week 38 of pregnancy to 1 week after delivery. Neonate therapy began 12 h after delivery and continued for 1 week. Both treatment regimens were well-tolerated in women and newborns. Lamivudine and zidovudine pharmacokinetics in pregnant women were similar to those in nonpregnant adults. Lamivudine and zidovudine freely crossed the placenta and were secreted in breast milk. Neonatal lamivudine clearance was about half that in pediatric patients; zidovudine clearance was consistent with previous reports. HIV-1 RNA could be quantified in 17 of the 20 women. At the onset of labor/delivery, mean virus load had decreased by approximately 1.5 log10 copies/mL in both treatment cohorts. Although not definitive for HIV-1 infection status, all neonates had HIV-1 RNA levels below the limit of quantification at birth and at ages 1 and 2 weeks.

The early natural history of vertically transmitted HIV-1 infection in African children from Durban, South Africa

Forty-eight children with vertically transmitted HIV-1 infection and 93 uninfected infants were followed up at regular intervals from birth for a mean of 26 months. They were examined physically, growth and development were assessed and illnesses recorded. Seventy per cent of infected infants were symptomatic by 6 months. Relative risks in the infected infants were highest for lymphadenopathy (4.56; CI 2.7-7.7), failure to thrive (4.48; 2.57-7.81), and neurological abnormalities (3.32; 1.9-5.58). The most frequent findings were diarrhoea (78%), pneumonia (76%) and lymphadenopathy (70%). Thrush and pneumonia occurred early but declined over time, whereas diarrhoea and neurological abnormalities occurred later and increased in frequency. A diagnosis of AIDS was made in 44% of infected infants by 12 months of age. Mortality in infected infants was 35.4%, and 76% of deaths occurred within the 1st year. About two-thirds of HIV-infected infants survived into early childhood. In South African children with vertically acquired HIV-1 infection the onset of disease is early and deterioration to AIDS and death are rapid. Infected infants can be easily recognized clinically, the majority by 6 months of age.

Breastfeeding by HIV-1-infected women and outcome in their infants: a cohort study from Durban, South Africa

BACKGROUND

Women in developing countries have the difficult choice of balancing the risk of transmitting HIV through breast milk against the substantial benefits of breastfeeding. It is not known, however, whether the benefits of breastfeeding are the same when the mother is HIV-infected. Therefore, we examined the impact of breastfeeding on infections, growth and mortality in the infants of HIV-1-infected women.

METHODS

Infants of HIV-1-positive women were followed from birth and at each visit they were examined, growth parameters were recorded and notes were made of feeding method, and of current and interim illnesses.

RESULTS

Of the 43 HIV-infected and 90 non-infected infants for whom feeding data were available, 36 infants (27%) were exclusively breastfed, 76 (57%) received mixed feeding, and 21 (16%) received formula only. The HIV transmission rate was 39% in those exclusively breastfed, 24% in those fed exclusively on formula and 32% in those receiving mixed feeding [relative risk (RR), 7.39; 95% confidence interval (CI), 1.67-32.6 between the exclusive breast and formula only groups]. There was a stepwise increase in the transmission rate with duration of exclusive breastfeeding of 1, 2 and 3 months (45%, 64%, and 75%, respectively). Of the infected infants, seven (50%) exclusively breastfed, 13 (51%) of those on mixed feeds and none on formula only developed AIDS; exclusively breastfed infants had a slower rate of progression to AIDS (mean age, 7.5 months versus 5.0 months, P = 0.2242) than those on mixed feeds. Mortality (which occurred in the infected infants only) was 19% in the exclusively breastfed infants; 13% in those on mixed feeds and 0% in those exclusively formula-fed. The frequency of failure to thrive and episodes of diarrhoea and pneumonia were not significantly different between the three groups in both the infected and non-infected infants.

CONCLUSIONS

Exclusive breastfeeding by HIV-infected women does not appear to protect their infants against common childhood illnesses and failure to thrive, nor does it significantly delay progression to AIDS. The implication of the trend towards differential mortality rates according to feeding groups is uncertain and requires further investigation.

Lymphocyte subset changes between 3 and 15 months of age in infants born to HIV-seropositive women in South Africa

The evolution of T-lymphocyte subsets during infancy in perinatally HIV-infected African babies has not been previously described. In a hospital-based cohort study, T-lymphocyte subset changes were investigated in 72 South African black children born to HIV seropositive mothers. Sixteen (22.2%; children were classified as infected and 56 (77.8%) as uninfected by 18 months of age. Four (25%) of the infected infants died before the age of 9 months from HIV-related disease. The CD4 and CD8 T-lymphocyte subsets, expressed in absolute numbers, as percentages, percentiles or as ratios, were clear indicators of HIV infection at all ages between 3 and 15 months. The most marked changes were a decreased percentage of CD4 cells and an increase in percentage of CD8 cells in the infected group. In the 4 infected infants who died, CD8 count and CD4:CD8 ratio clearly predicted poor clinical outcome at 3 months. Taken together, both CD4:CD8 ratio and CD4 percentage are reliable markers of HIV infection in an African paediatric population; however, a raised CD8 lymphocyte count rather than a CD4 count is a more specific prognostic marker of disease progression in HIV infected children.

The relationship between maternal-infant antibody levels and vertical transmission of HIV-1 infection

This study assesses the predictive value of the ratio of HIV-1 antibodies in the newborn at birth to that in the mother for perinatally transmitted infection confirmed subsequently by age 18 months. The ratio of HIV-1 (EIA) antibody levels in the baby at birth to that in the seropositive mother after the first trimester (sequenstration index SI) was available in 114 of a perinatal cohort of 137 infants. We related this ratio to the HIV infection status of the children by 18 months, HIV-1 DNA PCR and HIV-specific IgA antibody detection at birth, between 3 and 6 months, and morbidity and mortality. Thirty-five of the 137 (26 per cent) children were diagnosed as infected by 18 months. The mean (SD) HIV SI was 1.57 (0.88) in 29 infected and 0.83 (0.42) in 85 uninfected infants (P < 0.0001). Sensitivity and specificity of a threshold SI of 1.27 (mean +/- 2 SD of uninfected group) for the prediction of perinatal HIV-1 infection were 41 and 98 per cent, respectively. The reason for the higher SI in the infected babies is the combination of lower antibody titres in the transmitting mothers with raised levels in the infected babies. A similar analysis of antibody ratios showed no statistical differences for measles and tetanus (P > 0.1) between HIV infected and uninfected groups. There was a tendency to increased morbidity (Pearson's correlation coefficient r = 0.31) and more severe disease in those with higher HIV-1 SI. Three of 17 (18 per cent) peripheral blood samples from infected children at birth were PCR positive; all had SI's above the threshold. Overall sensitivity and specificity of PCR were 85 per cent each. Eleven of the 29 infected children were HIV-1 specific IgA positive at birth; six (64 per cent) of these had an SI > 1.27. This simple SI of HIV-1 EIA antibodies at birth is comparable to elaborate techniques in its power to predict perinatally acquired infection. It may be a cheap, reliable and rapid screening test for vertically transmitted HIV-1 infection.

HIV-1 specific immunoglobulin A antibodies as an effective marker of perinatal infection in developing countries

HIV-1 specific IgA antibody testing using commercially available reagents was evaluated at birth to 15 months in a group of infants born to HIV-seropositive South African women. Following IgG depletion of serum samples, 33/35 (94 per cent) of the infected infants and 3/99 (3 per cent) of the uninfected infants showed positive IgA reactivity. Sensitivity at birth was 24 per cent and improved with age; 82 per cent at 3 months, 87 per cent at 6 months and 94 per cent at 12 months. The overall positive and negative predictive values were 92 and 98 per cent, respectively. An evaluation of IgA and PCR in a subsample of infants indicated a better sensitivity of PCR within 3 months of birth, but IgA detection offered a higher overall sensitivity (87 v. 83 per cent) and specificity (91 v. 85 per cent). No significant difference in IgA level was observed between transmitting mothers and non-transmitting mothers. A moderate correlation existed between IgA level in the infant and the cumulative morbidity score, however a stronger association was observed between high IgA levels in the infected infant and rapid disease progression. The viral specific IgA assay is a simple, reliable and cost-effective diagnostic and prognostic test for perinatal HIV infection in developing countries.

Age-related pattern of immunoglobulins G, A and M in children born to HIV-seropositive women

In a cohort of 56 children born to HIV-seropositive African women, 19 met the criteria for HIV-infected children and 37 remained antibody-negative at 18 months of age. Blood samples taken at birth and 3-monthly until 18 months of age were processed and analysed by laser nephelometry for serum immunoglobulin (IgG, IgA and IgM) levels. In the infected group of children. higher levels of IgG were observed during their 1st 18 months of life reaching statistical significance at 3, 6, 15 and 18 months. Higher levels of IgA at 3 months and at 15 and 18 months, and higher levels of IgM at 3 months and 18 months later were statistically significant. All four infected children who died before the age of 6 months showed signs of hypergammaglobulinaemia (IgG and IgA) by 3 months of age. In this study the earliest and most common immunological abnormality was hypergammaglobulinaemia and infected infants with higher morbidity and mortality had more evident immunoglobulin abnormalities than infected children who survived. However, the immunological abnormalities in this small cohort did not precede the onset of severe symptoms and cannot therefore be used to predict clinical outcome.

Use of HIV-1 specific immunoglobulin G3 as a serological marker of vertical transmission

The objective of the study was to indicate HIV infection in infants. The patients were part of a longitudinal cohort of 43 infants born to HIV seropositive mothers. A modified Genelavia EIA primarily directed against HIV envelope proteins was used. An alkaline phosphatase labelled IgG3 conjugate was substituted in place of the kit conjugate. HIV specific IgG3 clearance was optimal at 6 months, whilst HIV total antibody was reliable only from age 12 months onwards. At 6 months no detectable IgG3 were found in 91 per cent of uninfected infants where more of these infants had reduced their total HIV antibody titres at the same period. We confirm that HIV specific IgG3 measurement is a reliable and cost effective means of identifying HIV infected infants from 6 months of age onwards.