The prevalence of refractive error in three communities of Cape Town, South Africa

The prevalence, distribution and demographic associations of refractive error in three communities in Cape Town, South Africa were assessed. In this cross-sectional study, a clustered random sampling procedure was used to recruit participants (n=176; age=40.6±14.7 years; males=76, females=96) from Khayelitsha, Milnerton, and Mitchell’s Plain. From March to May 2010, participants underwent autore-fraction and subjective refraction eye examinations.A structured interview was used to collect data on sociodemographics, age, gender, level of education, employment and race. Participants younger than 15 years, non-residents, or residents for less than six months, who declined signing the informed consent forms were excluded from the study. In this study myopia was defined as the spherical equivalent value in the better eye of −1.00D or worse and hyperopia as the spherical equivalent value in the better eye of ≥1.00D. Astigmatism was defined as −0.50 cylinder or worse in the better eye. The prevalence of myopia was 17.4% with a 90% confidence interval (CI) of 12.65-22.15, hyperopia was 13.4% (90% CI 9.13-17.67), and astigmatism was 60% (90% CI 53.86-66.14). Myopia was found to be significantly associated with race and age; while hyperopia was significantly associated with age, employment and race. The results of this study may assist in planning for eye care on district level. (S Afr Optom 2012 71(1) 32-38)

Prevalence and factors associated with depressive disorders in an HIV+ rural patient population in southern Uganda

BACKGROUND

Depressive disorders are estimated to occur in nearly half of HIV-infected individuals worldwide.

AIM

To examine the prevalence and cardinal demographic, psychosocial and clinical features associated with having any depressive disorder, sub-clinical depression, current and lifetime depressive disorders among patients with human immunodeficiency virus (HIV) in southern Uganda.

METHODS

Five hundred HIV+ individuals were screened for depression using a 20 item self-reporting questionnaire (SRQ-20) and evaluated with the mini neuropsychiatric interview(MINI) that assessed current and lifetime depressive disorders.

RESULTS

The prevalence estimates of any depressive disorder, subclinical depression, both current and lifetime major depression, and bipolar depression were 46.4%, 17.8%, 25% and 3.6% respectively. In comparison to non-depressed patients, those with sub-clinical depression were less likely to have high levels of self-efficacy, more likely to be using ART for less than one year, have advanced HIV disease and current alcohol use disorders (AUD's). Those with both current and lifetime depressive disorders were less likely to be 85% adherent to antiretroviral therapy (ART), have social support and high levels of self-efficacy, more likely to have tuberculosis and past manic episodes. Those with only lifetime depressive disorders were more likely to have current AUD's and past manic episodes.

LIMITATIONS

Information concerning exposures and outcomes was collected simultaneously, thus causal relationships are difficult to establish.

CONCLUSIONS

Sub-clinical depression, major depression and bipolar depression are widespread among HIV patients receiving ART. Integration of mental health services into HIV Care is desperately needed.

Antiretroviral effects on HIV-1 RNA, CD4 cell count and progression to AIDS or death: a meta-regression analysis

OBJECTIVE

Governments, clinicians and drug-licensing bodies have adopted changes in CD4 cell counts and HIV-1 RNA levels as evidence of effectiveness for new therapeutic interventions. We aimed to determine the strength of the association between the magnitude of the effect of changes in CD4 cell count and HIV-1 RNA and progression to AIDS or death in the highly active antiretroviral therapy (HAART) era.

METHODS

We identified all randomized clinical trials (RCTs) evaluating the effect of HAART on both clinical and surrogate endpoints (1994 to September 2006). We performed a meta-regression and weighted linear regression. We additionally estimated potential RCT sample sizes that would be required to assess the effectiveness of new interventions in terms of clinical endpoints.

RESULTS

We included data from 178 RCTs. We were unable to demonstrate a strong relationship at any time-point. Specifically, this was the case when CD4 T-cell change and clinical outcomes were examined at week 24 [coefficient -0.01, 95% confidence interval (CI) -0.03 to 0.001, P=0.54], week 48 (coefficient -0.01, 95% CI -0.02 to 0.001, P=0.83) and week 96 (coefficient 0.00, 95% CI -0.03 to 0.04, P=0.76). This was also the case when viral load was examined as a surrogate marker. Given the small number of clinical events occurring in new interventional RCTs, any RCT aiming to evaluate clinical endpoints within these time-points would require an exceptionally large sample size.

CONCLUSIONS

Our findings indicate that, within short-term clinical trial settings, it is not possible to estimate the proportion of treatment effect associated with surrogate endpoints.

Diagnosing smear-negative tuberculosis using case definitions and treatment response in HIV-infected adults

OBJECTIVE

To assess the diagnostic utility of expanded case definitions for HIV-associated smear-negative pulmonary tuberculosis (PTB) and extra-pulmonary TB (EPTB), and to derive objective criteria for response to anti-tuberculosis treatment.

DESIGN

A prospective cohort study of HIV-infected adults who met expanded clinical case definitions for smear-negative PTB and EPTB.

METHODS

All participants were started on rifampicin-based anti-tuberculosis treatment after mycobacterial cultures from multiple sites. At weeks 2, 4 and 8, response to treatment (RTT) was assessed by measuring changes in weight, haemoglobin, C-reactive protein, Karnofsky performance score and symptom count ratio.

RESULTS

Of 147 participants enrolled, 105 (71%) were diagnosed with definite (culture-positive) or probable (histological features) TB and 25 (17%) with possible TB (treatment response). The positive predictive value for the most common case definitions ranged from 89% to 96%. Significant improvements in all the RTT parameters occurred in the subjects with confirmed TB (P < 0.001). Clinically relevant RTT criteria were derived, two or more of which were met at week 8 in 97.5% of subjects with confirmed TB, 91.3% of subjects with possible TB and none of the subjects without TB.

CONCLUSION

Expanded case definitions could enhance the diagnosis of PTB and EPTB in HIV-infected adults in resource-limited settings. Using objective criteria, RTT can be assessed within 8 weeks of initiating anti-tuberculosis treatment.

Chronic disseminated histoplasmosis in an apparently immuno-competent Belgian patient

A 77 year-old Belgian man was admitted for weight loss and elevated liver enzymes. He used to live in Central Africa until 1986 and denied any travel outside Belgium during the last decade. Physical examination was unremarkable except for a lip ulceration. Blood tests showed increases of liver enzymes and CEA. In the search of an abdominal cancer, CT showed a normal liver but enlarged surrenal glands, while colonoscopy disclosed multiple mucosal lesions. Colic and lip biopsies identified Histoplasma capsulatum var capsulatum. HIV serology was negative. Lymphocyte count was normal but lymphocyte function was depressed. The patient dramatically improved under oral treatment with Itraconazole 400 mg daily for six months. This case indicates that chronic disseminated Histoplasmosis can reactivate in a healthy and apparently non-immunocompromised person living in Europe.

Impact of new developments in antiretroviral treatment on AIDS prevention and care in resource-poor countries

Combination antiretroviral treatment (ARV) including protease inhibitors, decreased the morbidity and mortality due to AIDS in the industrialized world. Many obstacles remain before ARVs can be introduced in resource-poor countries: high treatment costs, lack of laboratories to monitor the treatment, weak healthcare systems, and many other competing healthcare needs. The introduction of ARVs in resource-poor countries should be closely monitored. The first priority for the use of ARVs in resource-poor countries is the prevention of mother-to-child transmission of HIV. News about the success of ARV treatment may lead to an increase in unsafe behaviors including a decreased use of condoms. Therefore, prevention efforts should be strengthened; especially the development of an HIV vaccine needs to become a top priority. Funds for ARV treatment cannot come from the already strained healthcare budgets of resource-poor countries. The pressure on politicians and international donor agencies to provide ARVs to resource-poor countries should be used to increase overall healthcare budgets and to improve healthcare services in general.