Heterogeneity of HIV incidence : a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control

Objectives To describe HIV heterogeneity in rural Uganda using incidence data collected between January 2012 and December 2014 among fishing cohort (FC) and in an adjacent rural general population cohort (GPC). Methods In the FC, eligible HIV high-risk adults aged 18+ years were enrolled, followed and HIV tested every 3 months. Demographic and sexual behaviour data were also collected. The GPC, approximately 47 km away from the FC, was followed through annual surveys, and sociodemographic and behavioural data collected. A subset of GPC with comparable risk profiles to the FC was selected. We presented sociodemographic and risk profiles and also computed stratified HIV incidence. Cox regression was used to assess factors associated with HIV incidence. Results Overall HIV incidence was higher in the FC than in the ‘high-risk’ GPC, 6.04 and 0.56 per 100 person years at risk, respectively, with a rate ratio (RR) of 10.83 (95% CI 6.11 to 19.76). This was higher among those aged 18–24 years, unmarried and those with more than two sex partners in the past year, RR of 15.44, 22.99 and 19.29, respectively. In the FC, factors associated with high incidence in multivariate analysis were duration in the community and unprotected sex. The factors in the GPC were ethnicity, marital status and duration in the community. Conclusions We have observed a substantial heterogeneity in HIV incidence. The high incidence in fishing communities is contributing greatly to the overall HIV burden in Uganda, and thus urgent combination prevention efforts are needed towards national goal to reduce HIV epidemic

Strain differences in the humoral immune response to commensal bacterial antigens in rats

We have investigated the immune response to commensal bacterial species in the two inbred rat strains: Dark Agouti (DA) and Albino Oxford (AO). The predominant Gram-negative aerobe in our rats' intestinal bacterial flora was Escherichia coli, while Proteus mirabilis was isolated only from DA rat strain. We report that sera from both DA and AO rat strains contain specific IgG against predominant intestinal flora. Intramuscular administration of commensal bacterial antigens provoked only Th1-type antibody response in AO rats while DA rats developed mixed Th1- and Th2-type antibody response to E. coli and Th1-type response to P. mirabilis antigens. Weaker antibody production to own E. coli and higher serum levels of natural IgG and IgA P. mirabilis-specific antibodies combined with higher CD3+ cells proliferation was found in AO rats. Strain difference in the pattern of antibody production and differential regulation of immune response to commensal bacteria may contribute to the marked differences in the immune reactivity of AO and DA rats