The relationship of Plasmodium falciparum humeral immunity with HIV-1 immunosuppression and treatment efficacy in Zambia

<p>Abstract</p> <p>Background</p> <p>HIV-1 infection affects malaria humeral immunity during pregnancy, but data for non-pregnant adults are lacking. This study reports the impact of HIV-1 infection and other variables on the level of malaria humeral immunity in adults with clinical malaria and whether humeral immune suppression was a risk factor for treatment failure.</p> <p>Methods</p> <p>Sera of 224 HIV-1 infected and 115 uninfected adults were compared for IgG to merozoite antigens AMA-1 and MSP2 (3D7 and FC27 types) determined by ELISA, and for IgG to the Variant Surface Antigens (VSA) of three different parasite line E8B, A4 and HCD6 determined by flow cytometry.</p> <p>Results</p> <p>Compared to HIV-1 uninfected adults, AMA-1 IgG was lower in HIV-1 infected (<it>P </it>= 0.02) and associated with low CD4 count AMA-1 IgG (<it>P </it>= 0.003). Low IgG to all three merozoite antigens was associated with less anemia (<it>P </it>= 0.03). High parasite load was associated with low MSP2 IgG 3D7 and FC27 types (<it>P </it>= 0.02 and <it>P </it>= 0.08). Antibody levels to VSA did not differ between HIV-1 infected and uninfected adults. However, low VSA IgGs were associated with high parasite load (<it>P </it>≤ 0.002 for each parasite line) and with treatment failure (<it>P </it>≤ 0.04 for each parasite line).</p> <p>Conclusion</p> <p>HIV-1 affects humeral responses to AMA-1, but seems to marginally or not affect humeral responses to other merozoite antigens and VSAs. The latter were important for controlling parasite density and predict treatment outcome.</p

Mumps outbreak in an unimmunized population – Luanshya District, Copperbelt Province, Zambia, 2015

Introduction:&nbsp;mumps is a vaccine-preventable viral disease that may cause deafness, orchitis, encephalitis or death. However, mumps vaccine is not included in Zambia’s Expanded Program for Immunization. In January 2015, Integrated Disease Surveillance and Response data revealed an increase in reported mumps cases in Luanshya District. We investigated to confirm the etiology and generate epidemiological data on mumps in Zambia. Methods:&nbsp;we conducted active case finding, examined possible case-patients, and administered a standard questionnaire. A suspected mumps case was defined as acute onset of salivary gland swelling in a Luanshya resident during January - June 2015. Eight case-patients provided serum samples to test for mumps-specific immunoglobulin IgM, and buccal swabs to test for mumps viral RNA by RT-PCR, and genotyping of mumps virus at the Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Results:&nbsp;from January – June 2015, a total of 283 mumps cases were reported in Luanshya, peaking in April (71 cases) and clustering (81%) in two townships. Of 72 suspected case-patients interviewed, 81% were aged &lt; 15 years (29%, 1 - 4 years) and 61% were female. Common clinical characteristics were buccal tenderness (29%) and fever &gt; 37.5ºC (29%). Mumps virus genotype D was confirmed in five case-patients who tested positive by RT-PCR; six case-patients were sero-positive for anti-mumps IgM antibodies (total seven lab-confirmed cases). Conclusion:&nbsp;our findings represent the first reported epidemiologic description of mumps in Zambia. While the epidemiology is consistent with prior descriptions of mumps in unimmunized populations and no serious complications arose, this report provides data to inform policy discussions regarding mumps vaccination in Zambia

Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria.

BACKGROUND: In Zambia, malaria is one of the leading causes of morbidity and mortality, especially among under five children and pregnant women. For the latter, the World Health Organization recommends the use of artemisinin-based combination therapy (ACT) in the second and third trimester of pregnancy. In a context of limited information on ACT, the safety and efficacy of three combinations, namely artemether-lumefantrine (AL), mefloquine-artesunate (MQAS) and dihydroartemisinin-piperaquine (DHAPQ) were assessed in pregnant women with malaria. METHODS: The trial was carried out between July 2010 and August 2013 in Nchelenge district, Luapula Province, an area of high transmission, as part of a multi-centre trial. Women in the second or third trimester of pregnancy and with malaria were recruited and randomized to one of the three study arms. Women were actively followed up for 63 days, and then at delivery and 1 year post-delivery. RESULTS: Nine hundred pregnant women were included, 300 per arm. PCR-adjusted treatment failure was 4.7% (12/258) (95% CI 2.7-8.0) for AL, 1.3% (3/235) (95% CI 0.4-3.7) for MQAS and 0.8% (2/236) (95% CI 0.2-3.0) for DHAPQ, with significant risk difference between AL and DHAPQ (p = 0.01) and between AL and MQAS (p = 0.03) treatments. Re-infections during follow up were more frequent in the AL (HR: 4.71; 95% CI 3.10-7.2; p < 0.01) and MQAS (HR: 1.59; 95% CI 1.02-2.46; p = 0.04) arms compared to the DHAPQ arm. PCR-adjusted treatment failure was significantly associated with women under 20 years [Hazard Ratio (HR) 5.35 (95% CI 1.07-26.73; p = 0.04)] and higher malaria parasite density [3.23 (95% CI 1.03-10.10; p = 0.04)], and still women under 20 years [1.78, (95% CI 1.26-2.52; p < 0.01)] had a significantly higher risk of re-infection. The three treatments were generally well tolerated. Dizziness, nausea, vomiting, headache and asthenia as adverse events (AEs) were more common in MQAS than in AL or DHAPQ (p < 0.001). Birth outcomes were not significantly different between treatment arms. CONCLUSION: As new infections can be prevented by a long acting partner drug to the artemisinins, DHAPQ should be preferred in places as Nchelenge district where transmission is intense while in areas of low transmission intensity AL or MQAS may be used

A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis

Objectives To review evidence supporting use of fluoroquinolones as first line agents over other antibiotics for treating typhoid and paratyphoid fever (enteric fever)

Uptake of HIV testing and its associated factors among long-distance truck drivers in Zambia, 2015

Introduction: Globally, long distance truckers have been reported to have an important role in the spread of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV). Evidence on the uptake of HIV testing among this key population is not well established. We analysed the 2015 Behavioral Surveillance Survey (BSS) data to determine the uptake of HIV testing and assess factors associated with HIV testing among Long Distance Truck Drivers (LDTDs) in Zambia. Methods: We analysed secondary data from the 2015 BSS. The BSS was carried out in five of the 10 Corridors of Hope (COH) III project sites (Kazungula, Solwezi, KapiriMposhi, Chipata and Chirundu) among male LDTDs. The Zambian Corridors of Hope HIV and AIDS Prevention Initiative project was formed to address rising rates of HIV and other sexually transmitted infections. The BSS study included LDTDs from truck depots, border sites, Zambia Revenue Authority offices and those parked along the road side. Association between independent variables and history of HIV testing was determined by bivariate logistic analysis. Multivariable logistic regression was done to control for confounders. Results: Overall, 1,386 male LDTDs were included in the study, with mean age of 38 years. Over 75% reported being currently married and living with a spouse while 82% reported having only one wife. Uptake for ever having tested for HIV among LDTDs was 83%. Having a relative or friend who was infected or who had succumbed to HIV/AIDS (adjusted OR: 0.61, 95%CI: 0.40 – 0.92) and having two or more wives (adjusted OR: 0.4, 95%CI: 0.2 – 0.6) were independent inhibitory factors for uptake of HIV testing. Conclusion: Knowledge of someone infected or died of HIV and having at least two wives were drivers for HIV testing. These findings suggest the need to implement focused Behavioral Change interventions and messages to increase uptake of HIV testing among LDTDs