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Mycobacterium tuberculosis Beijing Genotype Is Associated with HIV Infection in Mozambique  [PDF]
Sofia O. Viegas, Adelina Machado, Ramona Groenheit, Solomon Ghebremichael, Alexandra Pennhag, Paula S. Gudo, Zaina Cuna, Egídio Langa, Paolo Miotto, Daniela M. Cirillo, Nalin Rastogi, Rob M. Warren, Paul D. van Helden, Tuija Koivula, Gunilla K?llenius
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0071999
Abstract: The Beijing genotype is a lineage of Mycobacterium tuberculosis that is distributed worldwide and responsible for large epidemics, associated with multidrug-resistance. However, its distribution in Africa is less understood due to the lack of data. Our aim was to investigate the prevalence and possible transmission of Beijing strains in Mozambique by a multivariate analysis of genotypic, geographic and demographic data. A total of 543 M. tuberculosis isolates from Mozambique were spoligotyped. Of these, 33 were of the Beijing lineage. The genetic relationship between the Beijing isolates were studied by identification of genomic deletions within some Regions of Difference (RD), Restriction Fragment Length Polymorphism (RFLP) and Mycobacterial Interspersed Repetivie Unit – variable number tandem repeat (MIRU-VNTR). Beijing strains from South Africa, representing different sublineages were included as reference strains. The association between Beijing genotype, Human Immunodeficiency Virus (HIV) serology and baseline demographic data was investigated. HIV positive serostatus was significantly (p=0.023) more common in patients with Beijing strains than in patients with non-Beijing strains in a multivariable analysis adjusted for age, sex and province (14 (10.9%) of the 129 HIV positive patients had Beijing strains while 6/141 (4.3%) of HIV negative patients had Beijing strains). The majority of Beijing strains were found in the Southern region of Mozambique, particularly in Maputo City (17%). Only one Beijing strain was drug resistant (multi-drug resistant). By combined use of RD and spoligotyping, three genetic sublineages could be tentatively identified where a distinct group of four isolates had deletion of RD150, a signature of the “sublineage 7” recently emerging in South Africa. The same group was very similar to South African “sublineage 7” by RFLP and MIRU-VNTR, suggesting that this sublineage could have been recently introduced in Mozambique from South Africa, in association with HIV infection.
Increased Severity and Mortality in Adults Co-Infected with Malaria and HIV in Maputo, Mozambique: A Prospective Cross-Sectional Study  [PDF]
Aase Berg, Sam Patel, P?l Aukrust, Catarina David, Miguel Gonca, Einar S. Berg, Ingvild Dalen, Nina Langeland
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0088257
Abstract: Background Co-infection with falciparum malaria and HIV-1 increases the severity and mortality of both infections in unstable malaria-transmission areas. In contrast, in stable transmission areas, HIV co-infection increases the severity of both infections but has not been found to influence malaria mortality. Methods In a prospective cross-sectional study, clinical and laboratory data were consecutively collected for all adults admitted with fever and/or suspected malaria to the medical department of the Central Hospital of Maputo, Mozambique, during two malaria seasons from January 2011. Malaria and HIV PCRs were performed, and risk factors for fatal outcomes were analysed. The impact of HIV on the clinical presentation and mortality of malaria was assessed. Findings A total of 212 non-pregnant adults with fever and/or suspected malaria and 56 healthy controls were included in the study. Of the 131 patients with confirmed falciparum malaria, 70 were co-infected with HIV-1. The in-hospital mortality of the co-infected patients was 13.0% (9/69) compared with 1.7% (1/59) in the patients without HIV (p = 0.018). Malaria severity (p = 0.016) and co-infection with HIV (p = 0.064) were independent risk factors for death although the association with HIV did not reach statistical significance. The co-infected patients had significantly more frequent respiratory distress, bleeding disturbances, hypoglycaemia, liver and renal failure and high malaria parasitemia compared with the patients with malaria alone. Interpretations HIV co-infection is associated with increased disease severity in and mortality from malaria in an area of stable malaria transmission. This finding was not observed earlier and should motivate doctors working in malaria-endemic areas to consider early HIV testing and a closer follow-up of patients with malaria and HIV co-infection.
Preliminary report of HIV and Toxoplasma gondii occurrence in pregnant women from Mozambique
Sitoe, Sonia Paula Benedito Luis;Rafael, Bernardete;Meireles, Luciana Regina;Andrade Jr., Heitor Franco de;Thompson, Ricardo;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2010, DOI: 10.1590/S0036-46652010000600002
Abstract: toxoplasmosis, a protozoan disease, causes severe disease in fetuses during pregnancy and deadly encephalitis in hiv patients. there are several studies on its seroprevalence around the world, but studies focusing on african countries are limited in number and mostly anecdotal. we studied two groups of samples from mozambique by elisa, using serum samples from 150 pregnant women and six cerebrospinal fluid (csf) samples from aids patients with encephalitis. hiv status was confirmed, and cd4 blood counts were obtained from hiv-positive pregnant women. igg seroprevalence of the group as a whole was 18.7% (28/150), with a higher prevalence in hiv-positive individuals compared to those who were hiv-negative (31.3%, [18/58] vs. 10.9%, [10/92]) patients. these data may be biased due to cumulative effects of exposition affecting disease prevalence. if corrected, this data may indicate an interaction of hiv and t. gondii. prevalence of both diseases increases with age, but this is more clearly seen for toxoplasmosis (p < 0.005) than hiv infection, possibly explained by higher transmission of hiv after childhood. in hiv patients suffering from encephalitis, csf serology showed that 33% of specific igg csf had a high avidity, which was in accordance with the data from the group of pregnant women. lower prevalence rates of both infections in older groups could be explained by more deaths in the infected groups, resulting in an artificially lower prevalence. using cd4 counts as a marker of time of hiv infection, and correcting for age, patients with contact with t. gondii had fewer cd4 cells, suggesting prolonged hiv disease or other causes. toxoplasma igg prevalence is higher in hiv+ groups, which could be ascribed to hiv- and t. gondii-associated risk factors, such as exposure to higher and more diverse social contacts. the low incidence of toxoplasma igg in younger age groups shows that transmission could be related to better access to cyst-containing meat in adulthood, as e
Validation of the Modes of Transmission Model as a Tool to Prioritize HIV Prevention Targets: A Comparative Modelling Analysis  [PDF]
Sharmistha Mishra, Michael Pickles, James F. Blanchard, Stephen Moses, Zara Shubber, Marie-Claude Boily
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0101690
Abstract: Background The static Modes of Transmission (MOT) model predicts the annual fraction of new HIV infections acquired across subgroups (MOT metric), and is used to focus HIV prevention. Using synthetic epidemics via a dynamical model, we assessed the validity of the MOT metric for identifying epidemic drivers (behaviours or subgroups that are sufficient and necessary for HIV to establish and persist), and the potential consequence of MOT-guided policies. Methods and Findings To generate benchmark MOT metrics for comparison, we simulated three synthetic epidemics (concentrated, mixed, and generalized) with different epidemic drivers using a dynamical model of heterosexual HIV transmission. MOT metrics from generic and complex MOT models were compared against the benchmark, and to the contribution of epidemic drivers to overall HIV transmission (cumulative population attributable fraction over t years, PAFt). The complex MOT metric was similar to the benchmark, but the generic MOT underestimated the fraction of infections in epidemic drivers. The benchmark MOT metric identified epidemic drivers early in the epidemics. Over time, the MOT metric did not identify epidemic drivers. This was not due to simplified MOT models or biased parameters but occurred because the MOT metric (irrespective of the model used to generate it) underestimates the contribution of epidemic drivers to HIV transmission over time (PAF5–30). MOT-directed policies that fail to reach epidemic drivers could undermine long-term impact on HIV incidence, and achieve a similar impact as random allocation of additional resources. Conclusions Irrespective of how it is obtained, the MOT metric is not a valid stand-alone tool to identify epidemic drivers, and has limited additional value in guiding the prioritization of HIV prevention targets. Policy-makers should use the MOT model judiciously, in combination with other approaches, to identify epidemic drivers.
Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil
Neilane Bertoni, Merril Singer, Cosme MFP Silva, Scott Clair, Monica Malta, Francisco I Bastos
Harm Reduction Journal , 2011, DOI: 10.1186/1477-7517-8-5
Abstract: To assess drug users' knowledge of HIV/AIDS and the possible association between knowledge and HIV testing.A Cross-sectional study conducted in 2006/7 with a convenience sample of 295 illicit drug users in Rio de Janeiro, assessing knowledge on AIDS/HIV transmission and its relationship with HIV testing. Information from 108 randomly selected drug users who received an educational intervention using cards illustrating situations potentially associated with HIV transmission were assessed using Multidimensional Scaling (MDS).Almost 40% of drug users reported having never used condoms and more than 60% reported not using condoms under the influence of substances. Most drug users (80.6%) correctly answered that condoms make sex safer, but incorrect beliefs are still common (e.g. nearly 44% believed HIV can be transmitted through saliva and 55% reported that HIV infection can be transmitted by sharing toothbrushes), with significant differences between drug users who had and who had not been tested for HIV. MDS showed queries on vaginal/anal sex and sharing syringes/needles were classified in the same set as effective modes of HIV transmission. The event that was further away from this core of properly perceived risks referred to blood donation, perceived as risky. Other items were found to be dispersed, suggesting inchoate beliefs on transmission modes.Drug users have an increased HIV infection vulnerability compared to the general population, this specific population expressed relevant doubts about HIV transmission, as well as high levels of risky behavior. Moreover, the findings suggest that possessing inaccurate HIV/AIDS knowledge may be a barrier to timely HIV testing. Interventions should be tailored to such specific characteristics.According to the United Nations General Assembly Special Session on HIV/AIDS' (UNGASS) indicators used for monitoring and evaluating HIV/AIDS policies [1], the Brazilian population has one of the highest levels of accurate knowledge abo
Jona, I.N. Phd,Vipene, J.B. Phd Department of Educational Foundations Rivers State University of Science and Technology, Port Harcourt, NIGERIA,Udo, H.I. (m.sc)
Academic Research International , 2011,
Abstract: The study was to determine the awareness of modes of HIV/AIDS transmission and prevention as correlates of sexual behaviour by physically handicapped female students in special schools inAkwa Ibom State. One hundred respondents were drawn for the study using a purposive sampling technique. Forty two item researchers’ made questionnaire titled AHTPMACSSB was used to collect data after being validated by experts. The data were analysed using percentages andPearson Product Moment Correlation Coefficient Statistical Technique. The results showed that the respondents were aware of the various modes of HIV/AIDS transmission. The findings also revealed that the respondents’ level of awareness of preventive measures did not correlate with their sexual behaviour. Based on these, it was recommended that high quality HIV/AIDS education be intensified in schools in Akwa Ibom State, Nigeria.
Knowledge, Attitudes and Perceptions of Secondary School Teenagers towards HIV Transmission and Prevention in Rural and Urban Areas of Central Uganda  [PDF]
Annamaria Rukundo, Mathias M. Muwonge, Danny Mugisha, Dickens Aturwanaho, Arabat Kasangaki, Godfrey S. Bbosa
Health (Health) , 2016, DOI: 10.4236/health.2016.810097
Abstract: HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly; weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can’t contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information
Transmission, Biochemical Manifestation and CD4+ Cell Count of HIV: A Review  [PDF]
M.M. Ahasan,M.M. Billah,M.M. Hasan,K.M.D. Islam
Pakistan Journal of Biological Sciences , 2004,
Abstract: Two genetically different related forms of human immunodefficiency virus (HIV), a human lentivirus belonging to the lentivirus family, called HIV-1 and HIV-2, have isolated from patients with AIDS. HIV can be transmitted through contaminated blood and blood products; from a mother to her offspring during pregnancy, childbirth or breast feeding; or through sexual contact. Sexual transmission remains by far the predominant mode of transmission. Vertical and blood borne transmission of HIV are highly predictable and very efficient modes. Sexual transmission of HIV, however, appears to be considerably less efficient and highly variable. During the early period after primary infection with HIV widespread of dissemination of the virus and a sharp decrease in the number of CD4+T cell count occurs. The use of CD4 cell count is an important indicator of disease severity of AIDS. The patients infected with AIDS can be attacked by various opportunistic infections such as pneumonia, Mycobacterium avium complex, cytomegalovirus, microsporidiosis and tuberculosis. The degree of intensity of these diseases can be indicated by measuring the level of enzyme like alkaline phosphatase, alanin aminotransferase and aspartate aminotransferase, lactate dehydrogenase and creatine phosphokinase.
A whole genome association study of mother-to-child transmission of HIV in Malawi
Bonnie R Joubert, Ethan M Lange, Nora Franceschini, Victor Mwapasa, Kari E North, Steven R Meshnick, the NIAID Center for HIV/AIDS Vaccine Immunology
Genome Medicine , 2010, DOI: 10.1186/gm138
Abstract: We conducted a nested case-control study of HIV MTCT using infants of HIV(+) mothers, drawn from a cohort study of malaria and HIV in pregnancy in Blantyre, Malawi. Whole genome scans (650,000 SNPs genotyped using Illumina genotyping assays) were obtained for each infant. Logistic regression was used to evaluate the association between each SNP and HIV MTCT.Genotype results were available for 100 HIV(+) infants (at birth, 6, or 12 weeks) and 126 HIV(-) infants (at birth, 6, and 12 weeks). We identified 9 SNPs within 6 genes with a P-value < 5 × 10-5 associated with the risk of transmission, in either unadjusted or adjusted by maternal HIV viral load analyses. Carriers of the rs8069770 variant allele were associated with a lower risk of HIV MTCT (odds ratio = 0.27, 95% confidence interval = 0.14, 0.51), where rs8069770 is located within HS3ST3A1, a gene involved in heparan sulfate biosynthesis. Interesting associations for SNPs located within or near genes involved in pregnancy and development, innate immunological response, or HIV protein interactions were also observed.This study used a genome-wide approach to identify novel variants associated with the risk of HIV MTCT in order to gain new insights into HIV MTCT etiology. Replication of this work using a larger sample size will help us to differentiate true positive findings.In sub-Saharan Africa, over 1,300,000 pregnant women were living with HIV in 2007, 73,000 of which were in the small southern country, Malawi, landlocked between Tanzania, Zambia, and Mozambique, just North of Zimbabwe [1]. More than 300,000 children were newly infected with HIV in 2007, predominantly through mother-to-child transmission (HIV MTCT) [2]. Much of the risk of HIV MTCT can be reduced by treatment with single dose nevirapine (NVP). However, in many areas, mothers and their infants do not receive such regimens, and even in the context of prophylactic treatment, some infants become infected whereas others remain free of infection. Fu
Update on microbicide research and development-seeking new HIV prevention tools for women
T Mertenskoetter, PE Kaptur
European Journal of Medical Research , 2011, DOI: 10.1186/2047-783x-16-1-1
Abstract: Current HIV incidence rates in highly impacted regions reflect the magnitude of the epidemic and point out an apparent lack of HIV prevention methods, specifically for women. Sixty-eight percent of the 2.3 million adults newly infected with HlV in 2008 live in sub-Saharan Africa, where approximately 60% of infected individuals are women [1]. Women and adolescent girls are especially vulnerable to HIV infection in sub-Saharan Africa not only because of their increased physiological susceptibility to heterosexual transmission, but also because of social, legal, and economic disadvantages [1]. According to the most recent estimate, the number of people living with HIV is 33.4 million [1]. In the nine countries in southern Africa affected most by HIV (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe), prevalence among young women aged 15-24 years was reported to be approximately 3 times higher than among men of the same age [2]. HIV prevention options for women are presently limited in this setting.Microbicides to prevent HIV infection in women are vaginally applied topical products that interfere with HIV infection at one or more steps in the replication cycle. This paper summarizes research to date on early generation product development efforts (polyanions, surfactants, acidifying agents) and next generation antiretroviral (ARV)-based HIV microbicides and introduces the concept of pre-exposure prophylaxis (PrEP) for the prevention of HIV transmission.Half of the exposed population currently has no effective means of self-initiated HIV prevention; and although condoms provide good protection from HIV infection, their regular use is not always negotiable by women. The effectiveness of an HIV prevention method is impacted by its correct and consistent use. Therefore, microbicide research and development has also focused on the topic of adherence, and factors affecting adherence, such as preferred dosage forms and regimens, st
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