The human immunodeficiency virus, (HIV-1), pandemic: cellular therapies, stem cells and biobanking

The Human Immunodeficiency Virus, (HIV-1), has become a major global health threat with recent estimates suggesting that 68% of people living with HIV (PLWH) reside in Sub-Saharan Africa. The current strategies for containment of this disease in the absence of an effective vaccine are of concern in terms of long-term fiscal sustainability and cost effectiveness. HIV prevalence rates are set to rise, not because of increasing incidence but rather because of the effort involved in implementing the anti-retroviral (ARV) programmes, especially on the African continent. Even when sub-optimally delivered, these therapies will lead to a decrease in mortality rates and prevent early death from opportunistic infections. However, evidence is emerging for long-term systemic effects of chronic HIV infection in persons on ARV therapy, including increased incidence of Haematological abnormalities and malignancies.

Impact of the HIV epidemic and Anti-Retroviral Treatment policy on lymphoma incidence and subtypes seen in the Western Cape of South Africa, 2002-2009: preliminary findings of the Tygerberg Lymphoma Study Group

The Tygerberg Lymphoma Study Group was constituted in 2007 to quantify the impact of HIV on the pattern and burden of lymphoma cases in the Western Cape of South Africa which currently has an HIV prevalence of 15%. South Africa has had an Anti-Retroviral Treatment (ART) policy and a roll-out plan since 2004 attaining 31% effective coverage in 2009. This study is designed to qualify and establish the impact of HIV epidemic and the ARV roll-out treatment program on the incidence of HIV Related Lymphoma (HRL). Early data document that despite the ART roll out, cases of HRL are increasing in this geographical location, now accounting for 37% of all lymphomas seen in 2009 which is an increase from 5% in 2002. This is in contrast to trends seen in developed environments following the introduction of ART. Also noted are the emergence of subtypes not previously seen in this location such as Burkitt and plasmablastic lymphomas. Burkitt lymphoma is now the commonest HRL seen in this population followed by diffuse large B-cell lymphoma subtypes. The reasons for this observed increase in HRL are not ascribable to improved diagnostic capacity as the tertiary institute in which these diagnoses are made has had significant expertise in this regard for over a decade. We ascribe this paradoxical finding to an ART treatment environment that is ineffective for a diversity of reasons, paramount of which are poor coverage, late commencement of ART and incomplete viral suppression.

Use of novel proteosome inhibitors as a therapeutic strategy in lymphomas current experience and emerging concepts

Precedent from preclinical experiments coupled with two pivotal phase 2 studies in myeloma has focused attention on a potential role for ubiquitin-proteasome pathway in modulating a number of events that occur commonly in the neoplastic process involving proteins in the regulation of cells cycling, growth and differentiation. This influence is vested in the proteasomes which are large complexes of proteolytic enzymes responsible for degradation of many of these intracellular messengers. Logically interest has centred on molecules having the capacity to influence, by degradation, such molecules and although a number of agents are in development bortezomib is the only one currently in clinical use. Velcade, formerly PS-341, is a novel dipeptide boronic acid capable of reversibly inhibiting the 26S proteasome through a range of activities. The latter are anti-proliferative and proapoptotic with the latter blocking nuclear transcription via NF-kappa B in addition to down regulating adhesion and inhibiting angiogenesis. Additional changes are mediated in protein folding within the endoplasmic reticulum and contribute to cell death. These concepts are given focus by considering their introduction into treatment of lymphoreticular malignancy.

Aids is now the commonest clinical condition associated with multilineage blood cytopenia in a central referral hospital in Zimbabwe

OBJECTIVE

To describe the clinical features and diagnosis of patients hospitalised and found to have multilineage peripheral blood cytopenias.

DESIGN

Prospective cross sectional study.

SETTING

Parirenyatwa Hospital, a central referral hospital in Harare, Zimbabwe.

SUBJECTS

231 consecutive patients whose blood parameters revealed bi- or trilinneage cytopenia during a five month period in 1996.

MAIN OUTCOME MEASURES

1. Blood cytopenia was described as: (a) Haemoglobin concentration = or < 100 g/L (b) Total leucocyte count = or < 3.5 x 10(9)/L (c) Platelet count = or < 100 x 10(9)/L 2. Other clinical and diagnostic features.

RESULTS

The highest percentage of multilineage blood cytopenia was in the age bracket 30 to 44 years and the male to female ratio was 1.4:1. Pancytopenia was found in 32.5% of patients, while bilineage cytopenia occurred in 67.5%. The commonest bilineage pattern was the combination of anaemia and thrombocytopenia occurring in 46.3% of all study cases or 68.5% of bilineage cytopenias. Anaemia was the most frequent cytopenia; it was found in 95.2% of all study cases.

CONCLUSION

The commonest condition with which multilineage blood cytopenia was associated was AIDS which was diagnosed in 25.1% of the study cases.

Use of packed red cells in a major hospital in Harare, Zimbabwe

OBJECTIVES

To document the current pattern of packed red cell (PC) usage and the crossmatch to transfusion ratio (C/T ratio) in a major city teaching hospital in Harare, Zimbabwe.

DESIGN

Restropective, (audit).

SETTING

Harare Central Hospital, a 1,200 bed multidisciplinary hospital located in Harare, Zimbabwe.

MAIN OUTCOME MEASURES

Amount of PC ordered and proportion collected for the year 1995. Quantity of PC used by different medical specialties.

RESULTS

In 1995 a total of 8,292 PC were collected from Harare Hospital blood bank. This translates to an average PC usage for a 1,200 bed hospital of seven units per hospital bed per year. Only 48.5% of PC crossmatched was collected with a C/T ratio of 2.1:1. Revenue loss of Z$478,434 is estimated to have occurred due to expired units and resource wastage from uncollected crossmatched units. The largest consumer of PC was the Department of Gynaecology, followed by Surgery and Paediatrics.

CONCLUSION

Regular auditing of blood usage is recommended to promote the efficient use of PC in accordance with accepted international standards and local guidelines and practice.

Accidental HIV exposure

This is a case presentation of an accidental contaminated needle stick injury from a patient known to be infected with both Human Immunodeficiency Virus (HIV) and hepatitis B. The patient was managed with prophylactic hepatitis B immune globulin, hepatitis B vaccination and the HIV retroviral drug zidovudine (AZT). At one year after treatment the patient was not infected with HIV or hepatitis B, and there was adequate immunity generated after vaccination for hepatitis B.

Primary cerebral lymphoma in Zimbabwe: a report of three patients

Primary central nervous system lymphoma (PCNSL) is steadily increasing. Immunosuppressed individuals are at particular risk. In AIDS patients a clinical diagnosis of PCNSL is made in 0.5 to 8.4%, and a post mortem diagnosis in up to 11% of cases. In spite of the extensive HIV epidemic in parts of Africa, a literature search revealed only one African report of this condition. The reasons for this apparent infrequency are not clear. Possibilities include under diagnosis or early demise of patients due to other AIDS related illnesses of earlier onset. Three patients with primary cerebral lymphoma from Zimbabwe are presented. All were young, with tumours of high grade showing typical features.

von Willebrand factor in diabetic retinopathy

OBJECTIVE

To elucidate the qualitative nature of elevated levels of von Willebrand factor (vWF) in diabetic microagiopathy.

DESIGN

A randomized controlled study.

SETTING

Oxford Health Authority, Oxfordshire, United Kingdom.

SUBJECTS

Insulin dependent diabetic patients with established retinopathy, and an age, sex matched control group.

MAIN OUTCOME MEASURES

Diabetic retinopathy, a modified enzyme-linked immunosorbent assay (ELISA), used to distinguish between endothelial and plasma type vWF.

RESULTS

vWF is higher in patients with diabetic retinopathy mean (217u/dl) compared with normal subjects mean (8/u/dl). vWF in both patient and control are of the plasma type.

CONCLUSION

vWF in diabetic retinopathy is raised and of the plasma type, suggesting it is not due to acute vascular endothelial injury.