HIV/AIDS: global trends, global funds and delivery bottlenecks

Globalisation affects all facets of human life, including health and well being. The HIV/AIDS epidemic has highlighted the global nature of human health and welfare and globalisation has given rise to a trend toward finding common solutions to global health challenges. Numerous international funds have been set up in recent times to address global health challenges such as HIV. However, despite increasingly large amounts of funding for health initiatives being made available to poorer regions of the world, HIV infection rates and prevalence continue to increase world wide. As a result, the AIDS epidemic is expanding and intensifying globally. Worst affected are undoubtedly the poorer regions of the world as combinations of poverty, disease, famine, political and economic instability and weak health infrastructure exacerbate the severe and far-reaching impacts of the epidemic. One of the major reasons for the apparent ineffectiveness of global interventions is historical weaknesses in the health systems of underdeveloped countries, which contribute to bottlenecks in the distribution and utilisation of funds. Strengthening these health systems, although a vital component in addressing the global epidemic, must however be accompanied by mitigation of other determinants as well. These are intrinsically complex and include social and environmental factors, sexual behaviour, issues of human rights and biological factors, all of which contribute to HIV transmission, progression and mortality. An equally important factor is ensuring an equitable balance between prevention and treatment programmes in order to holistically address the challenges presented by the epidemic

Adolescence: The Age of Proteus

This article focuses on adolescents as a group, who are exposed to major changes in their near future, with the key transformation being theepidemiological transition from the age of infectious and nutritional problems to that of the non-communicable disorders (NCDs). The major NCDsare: obesity, diabetes, maternal, newborn and child, hypertension and mental health disorders. We also discussallergies, exposure to pollutants, indooropen stoves, and behavioural factors, such as lack of exercise, unhealthy diet, substance abuse, injuries and violence, and sexually transmitted diseases,which contribute to a risky environment. We particularly emphasise the continuum from birth to old age, during which early events may producelifelong diseases, and which requires serious attention with regard to preventive measures during the earliest period of susceptibility. Some indicatorsof disease can serve as diagnostic markers and help healthcare workers to avoid complications and manage a disorder efficiently

The antimicrobial properties and chemical composition of leaf extracts and essential oils of indigenous Pteronia species

Abstract The genus Pteronia consists of approximately 80 species which are widely distributed in southern Africa. For hundreds of years the indigenous people of southern Africa have turned to the earth in order to provide healing for their people. The genus Pteronia has been amongst the first species to be used by the San and Khoi-San people for treating infections and stomach ailments. Ten species were selected for the purpose of this report. The essential oils were isolated by using a Clevenger-type apparatus while the non-volatiles were extracted with acetone and methanol. The essential oils and extracts were assessed for antimicrobial activity. The disc diffusion assays included three Gram-negative bacteria; Escherichia coli, Yersinia enterocolitica and Klebsiella pneumoniae, three Gram-positive bacteria; Staphylococcus aureus, Bacillus subtilis and Bacillus cereus as well as one yeast; Candida albicans. Results indicated that the species were primarily active against Gram-positive organisms. The minimum inhibitory concentration of the ten most active species (essential oils and extracts) were determined using the microdilution method. The most promising activity was noted for P. fasiculata which had a MIC of 0.22 mg/ml against S. aureus, 0.39 mg/ml against B. cereus and 2.08 mg/ml against B. subtilis. The essential oils analysis by GC/MS revealed two chemotypes. In Pteronia pallens, P. empetrifolia and P. flexicaulis rare compounds, such as presilphiperfolol-7-ene, 7-α-(H)-silphiperfol-5-ene, 7-β-(H)-silphiperfol-5-ene, α-campholene aldehyde, silphiperfol-5-ene, camaroonan-7-α-ol, silphiperfol-7- β -ol, presilphiperfolan-9- α -ol and presilphiperfolan-8-ol (a major compound in Pteronia pallens) were recorded. A cluster analysis of the essential oil data indicated that individual collections of P. camphorata within a population were tightly clustered. Similarly, P. pallens sampled from three different localities were also united in the cluster analysis. These results suggest minimal within and between population variations for some of the species studied

Infectious diseases at the paediatric isolation units of Clairwood and King Edward VIII Hospitals, Durban

Objective. Information on diseases of public health importance is scanty or  unavailable in South Africa as a result of a weak health surveillance system. Large institutional databases of common diseases can, therefore, provide useful ancillary information for planning and policy, despite unavoidable selection bias. We conducted a 12-year retrospective review (1985 - 1996) of all children admitted to the only isolation facility for the Durban metropolitan region. ·Our aim was to document changes in admissions and mortality for common childhood infectious diseases and to detect any impact of the HIV epidemic on these diseases.Results. During these years 19 037 children were admitted and annual admissions decreased by 79%. Measles accounted for the majority of admissions (58%), followed by varicella at 23%. No cases of poliomyelitis, diphtheria or cholera have been seen since 1990. Typhoid fever, mumps, tetanus and pertussis have  decreased, but remain at low endemic levels. Between 1994 and 1996, 1% of measles and 15.3% of varicella cases have been associated with illV-l infection; this has resulted in 56% of measles deaths and 75% of varicella deaths occurring in HIV co-infected children. Overall, 60% of deaths during the past 3 years have been in illV co-infected children. HIV testing based solely on clinical suspicion was performed in 11% and 29% of measles and varicella cases, respectively. Average all-disease mortality was 5.3%, a decrease of 87% over the study period, with measles accounting for most deaths (86%).Conclusions. The changing profile of childhood infectious diseases described at the paediatric isolation units is consistent with available national data. Probable reasons for these changes are the shift in emphasis to primary health care issues, and a gradual improvement in socio-economic conditions of the poor

Routinely available cotrimoxazole prophylaxis and occurrence of respiratory and diarrhoeal morbidity in infants born to HIV-infected mothers in South Africa

Objectives. To examine the influence of cotrimoxazole (CTM) prophylaxis on incidence of lower  respiratory tract infections (LRTis) and diarrhoea.Design. A prospective observational cohort study. Morbidity and feeding data on infants born to HN-infected mothers were collected routinely at. clink visits at 1 week, 6 weeks and 3 months, and 3-monthly thereafter, with blood drawn for determining HIV status.Setting. Two hospitals in Durban, South Africa. In one hospital (King Edward VIII Hospital), infants born to HIVinfected mothers recieved CTM prophylaxis and in the other (McCord Hospital) infants did not  receive CTM prophylaxis,Subjects. Infants born to HIV-infected mothers.Outcome measures. Incidence of .LRTI and diarrhoea.Results, Ill. multivariate analysis controlling for breast-feeding status, number of clinic visits and HN infection status, HIVinfected infants with access to C1M prophylaxis had a significantly lower incidence of LRTI (82%) than those without access to prophylaxis. However in HIV-uninfected infants, this was not the case, CTM prophylaxis was associated with a non-significant increased risk for diarrhoea in both infected (odds ratio (OR) 1.58, p = 0.45) aud uninfected infants (OR 1.52, p = 0.10).Conclusions, This observational study .confirms current thinking that CTM prophylaxis is protective  against LRTis in HIV-infected children. However, because of a possible association between CTM prophylaxis and an increased risk of diarrhoea, HIV status of infants should be determined as early as possible in order to prevent tmnecessary exposure of uninfected infants to CTM prophylaxis, while further studies to quantify both beneficial and adverse effects. of CTM prophylaxis are undertaken

HBV and proteinuria in relatives and contacts of children with hepatitis B virus-associated membranous nephropathy

HBV and proteinuria in relatives and contacts of children with hepatitis B virus-associated membranous nephropathy.BackgroundHepatitis B virus (HBV)-associated membranous nephropathy (HBVMN) is an important cause of childhood nephrotic syndrome in regions endemic for the virus, but little is understood of the biosocial context in which the disease develops. We evaluated HBV status and proteinuria in family members and household contacts of index children with HBVMN to test the hypothesis that HBV carriage and asymptomatic proteinuria are closely linked and may be causally associated.MethodsThirty-one black children with biopsy-proven HBVMN were the index cases. One hundred and fifty-two family members and 43 black household contacts were the subjects of the study. We assessed HBV carrier status by testing for HBV antigens and antibodies using enzyme-linked immunosorbent assays (ELISA) and for HBV DNA by using slot-blot hybridization and the polymerase chain reaction. Sequencing of the precore region of HBV was done in a subset of both index cases and subjects. Proteinuria was assessed by measuring the urinary protein/creatinine ratio.ResultsSeventy-two (37%) of the 195 family members and household contacts were HBV carriers, and 53 (27%) had a protein/creatinine ratio greater than the physiological limit. The frequency of abnormal proteinuria was not significantly different in those with [22 out of 72 (30.5%)] or without [33 out of 104 (32%)] HBV carriage. This lack of association remained when carriers were classified into those who were HBsAg positive only and those with active viral replication (HBsAg and/or HBeAg and/or HBV DNA; P = 0.01). Family members were more predisposed to HBV carriage than household contacts, but abnormal proteinuria was present with equal frequency (P = 0.48). Age had a significant impact on proteinuria, with children less than five years being more likely to have abnormal proteinuria (P = 0.008). The prevalence of abnormal proteinuria in family members and household contacts of the index cases was more than that in community-based controls. The 10 index HBVMN cases and the 14 family members and household contacts who were tested all had HBV of genotype A.ConclusionThese results suggest that the family members and household contacts of children with HBVMN are at very high risk of HBV carriage; they also have asymptomatic proteinuria at a significantly higher rate than community-based controls. The HBV carrier status was not associated with proteinuria, a finding supported by peak prevalences of proteinuria in those under five years but no corresponding peak for HBV carriage. Proteinuria may indicate glomerular basement membrane dysfunction. Environmental and social factors may underpin development of these two covert disorders, but are insufficient to account for the index cases of HBVMN. The emergence of children with HBVMN from such households additionally depends on unidentified and possibly genetic factors

Scientific justification for the participation of children and adolescents in HIV-1 vaccine trials in South Africa

No Abstract

HIV-1 subtype C envelope characteristics associated with divergent rates of chronic disease progression

<p>Abstract</p> <p>Background</p> <p>HIV-1 envelope diversity remains a significant challenge for the development of an efficacious vaccine. The evolutionary forces that shape the diversity of envelope are incompletely understood. HIV-1 subtype C envelope in particular shows significant differences and unique characteristics compared to its subtype B counterpart. Here we applied the single genome sequencing strategy of plasma derived virus from a cohort of therapy naïve chronically infected individuals in order to study diversity, divergence patterns and envelope characteristics across the entire HIV-1 subtype C gp160 in 4 slow progressors and 4 progressors over an average of 19.5 months.</p> <p>Results</p> <p>Sequence analysis indicated that intra-patient nucleotide diversity within the entire envelope was higher in slow progressors, but did not reach statistical significance (p = 0.07). However, intra-patient nucleotide diversity was significantly higher in slow progressors compared to progressors in the C2 (p = 0.0006), V3 (p = 0.01) and C3 (p = 0.005) regions. Increased amino acid length and fewer potential N-linked glycosylation sites (PNGs) were observed in the V1-V4 in slow progressors compared to progressors (p = 0.009 and p = 0.02 respectively). Similarly, gp41 in the progressors was significantly longer and had fewer PNGs compared to slow progressors (p = 0.02 and p = 0.02 respectively). Positive selection hotspots mapped mainly to V1, C3, V4, C4 and gp41 in slow progressors, whereas hotspots mapped mainly to gp41 in progressors. Signature consensus sequence differences between the groups occurred mainly in gp41.</p> <p>Conclusions</p> <p>These data suggest that separate regions of envelope are under differential selective forces, and that envelope evolution differs based on disease course. Differences between slow progressors and progressors may reflect differences in immunological pressure and immune evasion mechanisms. These data also indicate that the pattern of envelope evolution is an important correlate of disease progression in chronic HIV-1 subtype C infection.</p