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

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

Interventions to enhance the teaching status of parasitology.

Recent surveys have highlighted an erosion of the teaching of parasitology in medical and veterinary schools across Europe and other developed countries, despite reports of increasing instances of food and water borne parasitic infections in these regions. To facilitate the teaching of this subject, essential to develop future health care professionals, we are performing different interventions at De Montfort University (DMU, UK). Briefly, these include: a) curriculum modifications to increase the time dedicated to the study of parasitology; and b) implementation of web-based resources in the curricula for enhancing teaching (e.g. through introduction of blended learning) and to encourage self-learning and participation among the students. Thus, DMU is leading the development of an on-line package for teaching and learning parasitology named DMU e-Parasitology in collaboration with different European academics and clinicians. This package has four sections: a theoretical section with mini e-learning modules to study major human parasitic diseases; virtual laboratory describing major techniques used in parasitology; a microscopy section with resources to enhance the study of parasites; a section with virtual clinical case studies to encourage self-learning. To assess the effectiveness of DMU e-Parasitology as a learning resource, we have done preliminary testing with final year BSc Biomedical Science students at DMU (n=194; 2017/18). 94.5% of students highlighted they gained appropriate knowledge of the pathology, prevention and treatment of some parasitic diseases; and 93.1% indicated that they learnt basic skills to investigate parasitic disease. The interventions and resources described could be used to improve the teaching status of medical parasitology in human health degrees

A descriptive study of the spectrum of dermatological surgery services provided by the University of KwaZulu-Natal Department of Dermatology at Inkosi Albert Luthuli Central Hospital

A descriptive study of the spectrum of dermatological surgery services provided by the University of KwaZulu-Natal Department of Dermatology at Inkosi Albert Luthuli Central Hospita

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

Vaginal yeast infections in diabetic women

Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for the presence of yeasts and Trichomonas vaginalis. Yeasts were isolated from the vaginas of 35,5% of patients and were more common in the symptomatic group (48,0%) than the asymptomatic group (25,4%; P < 0,(5). Candida albicans was isolated from 12,8% of all patients and showed a significant association with pruritus vulvae (P < 0,(5). A significant association was also shown between the presence of yeasts in the rectum and in the vagina. C. glabrata (Torulopsis glabrata) was the COmDlonest yeast species isolated (50,0%), with C. albicans the next most frequent (36,1%). T. vaginalis infection was present in 14,3% of all subjects

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

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

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