Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda

Objectives We investigated phenotypic and genotypic resistance after 2 years of first-line therapy with two HIV treatment regimens in the absence of virological monitoring. Methods NORA [Nevirapine OR Abacavir study, a sub-study of the Development of AntiRetroviral Therapy in Africa (DART) trial] randomized 600 symptomatic HIV-infected Ugandan adults (CD4 cell count <200 cells/mm3) to receive zidovudine/lamivudine plus abacavir (cABC arm) or nevirapine (cNVP arm). All virological tests were performed retrospectively, including resistance tests on week 96 plasma samples with HIV RNA levels ≥1000 copies/mL. Phenotypic resistance was expressed as fold-change in IC50 (FC) relative to wild-type virus. Results HIV-1 RNA viral load ≥1000 copies/mL at week 96 was seen in 58/204 (28.4%) cABC participants and 21/159 (13.2%) cNVP participants. Resistance results were available in 35 cABC and 17 cNVP participants; 31 (89%) cABC and 16 (94%) cNVP isolates had a week 96 FC below the biological cut-off for tenofovir (2.2). In the cNVP arm, 16/17 participants had resistance mutations synonymous with high-level resistance to nevirapine and efavirenz; FC values for etravirine were above the biological cut-off in 9 (53%) isolates. In multivariate regression models, K65R, Y115F and the presence of thymidine analogue-associated mutations were associated with increased susceptibility to etravirine in the cABC arm. Conclusions Our data support the use of tenofovir following failure of a first-line zidovudine-containing regimen and shed further light on non-nucleoside reverse transcriptase inhibitor hypersusceptibility

No evidence for association with APOL1 kidney disease risk alleles and Human African Trypanosomiasis in two Ugandan populations:

Human African trypanosomiasis (HAT) manifests as an acute form caused by Trypanosoma brucei rhodesiense (Tbr) and a chronic form caused by Trypanosoma brucei gambiense (Tbg). Previous studies have suggested a host genetic role in infection outcomes, particularly for APOL1. We have undertaken a candidate gene association studies (CGAS) in a Ugandan Tbr and a Tbg HAT endemic area, to determine whether polymorphisms in IL10, IL8, IL4, HLAG, TNFA, TNX4LB, IL6, IFNG, MIF, APOL1, HLAA, IL1B, IL4R, IL12B, IL12R, HP, HPR, and CFH have a role in HAT

Integrated Mapping of Neglected Tropical Diseases: Epidemiological Findings and Control Implications for Northern Bahr-el-Ghazal State, Southern Sudan

Integrated control of neglected tropical diseases (NTDs) is being scaled up in a number of developing countries, because it is thought to be more cost-effective than stand-alone control programmes. Under this approach, treatments for onchocerciasis, lymphatic filariasis (LF), schistosomiasis, soil-transmitted helminth (STH) infection, and trachoma are administered through the same delivery structure and at about the same time. A pre-requisite for implementation of integrated NTD control is information on where the targeted diseases are endemic and to what extent they overlap. This information is generated through surveys that can be labour-intensive and expensive. In Southern Sudan, all of the above diseases except onchocerciasis require further mapping before a comprehensive integrated NTD control programme can be implemented. To determine where treatment for which disease is required, integrated surveys were conducted for schistosomiasis, STH infection, LF, and loiasis, throughout one of ten states of the country. Our results show that treatment is only required for urinary schistosomiasis and STH in a few, yet separate, geographical area. This illustrates the importance of investing in disease mapping to minimize overall programme costs by being able to target interventions. Integration of survey methodologies for the above disease was practical and efficient, and minimized the effort required to collect these data

A Cross-sectional Study to Assess Bacteriological Quality of Fresh Vegetable Salads and Associated Risk Factors in Food Service Establishments in Mwanza City

This study examined the bacteriological quality of fresh vegetable salads and associated risk factors in restaurants and street food vendors in Nyamagana and Ilemela municipalities, Mwanza City, Tanzania. Thirty samples of vegetable salads (i.e., Kachumbari), along with 30 swabs from hands and chopping boards, were collected and analyzed. High contamination levels exceeding acceptable limits were observed with total bacterial counts, S. aureus, and E. coli ranging from 3.6 to 6.7 log CFU/g. All Kachumbari samples (100%) were unsatisfactory, and 17 (56.7%) had unsatisfactory E. coli levels. Moreover, 22 samples (73.3%) had unsatisfactory S. aureus levels, and 10 samples (33.3%) showed unsatisfactory Salmonella spp. contamination. Further, Kachumbari from street food vending sites had a significantly (p &lt; 0.05) higher TBC mean value (6.5 ± 0.3 log CFU/g) than the one from restaurants (5.2 ± 0.6 log CFU/g). On the other hand, chopping boards and hands had high total counts ranging from 3.5 to 4.7 log CFU.cm-2. Also, the type of chopping board was significantly related to the S. aureus contamination levels in the Kachumbari salads (p &lt; 0.05). The presence of both hygiene indicator microorganisms and pathogens indicates a potential public health risk associated with the consumption of Kachumbari. Urgent intervention measures are required to enhance handling practices, personal hygiene, and overall safety throughout the food value chain, thus ensuring the quality and safety of vegetable salads in food service establishments