4 research outputs found
Book Reviews
ImmunoparasitologyImmunoparasitology: Principles and Methods in Malaria and Schistosomiasis Research. Ed. by G. T. Strickland and K. W. Hunter. Pp. 294. Illustrated. £29,75. London: Praeger. 1982.Walsh and Hoyt's Clinical Neuro-Ophthalmology, vol. 1. By Neil R. Miller. Pp. xii +381. Illustrated. R66,-. Baltimore: Williams & Wilkins. 1982Urinary tract infectionUrinary Tract Infection (Currenr Topics in Infection, No. 3). By R. Maskell. Pp. viii + 144. Illustrated. R37,-. London: Edward Amold. 1982.Common Health Problems in Medical Practice. By E. Scott Medley. Pp. xvi +343. Illustrated. Baltimore: Williams & Wilkins. 1982.Endocrine pathologyEndocrine Pathology: General and Surgical. 2nd ed. Ed. by J. M. B. Bloodworth jun. Pp. xii + 895. Illustrated. Baltimore: Williams & Wilkins. 1982.Experimental Hematology Today, 1982. Ed. by S. J. Baum, D. D. Ledney and S. Thierfelder. Pp. xx +266. Illusuated. DM 237,-. Basle: S. Karger. 1982.Medical Disorders of Alcoholism: Pathogenesis and Treatment (Major Problems in International Medicine, vol. XXII). By C. S. Lieber. Pp. xvii + 589. Illusuated. ± RI08,-. Philadelphia: W. B. Saunders. 19.82.Breast Cancer (Clinics in Oncology, No. I, vol. 3). Guest ed. M. Baum. Pp. vii +647 + 955. Illustrated. Rll,75. Philadelphia: W. B. Saunders. 1982.Handbook of Medical Parasitology. By Viqar Zaman and Loh Ah Keong. Pp. viii + 218. Illustrated. £17,-. New York: ADIS Health Science Press. 1982
The association between ulcerative colitis and chronic liver disease at Tygerberg Hospital
The original publication is available at http://www.samj.org.zaTwenty consecutive patients with ulcerative colitis were evaluated at the Gastro-intestinal Clinic, Tygerberg Hospital, with special reference to the biochemical tests and histological findings in the liver. Abnormal liver function tests warrant a liver biopsy, since the underlying liver disease influences the subsequent prognosis and treatment.Publishers' versio
The association between ulcerative colitis and chronic liver disease at Tygerberg Hospital
The original publication is available at http://www.samj.org.zaTwenty consecutive patients with ulcerative colitis were evaluated at the Gastro-intestinal Clinic, Tygerberg Hospital, with special reference to the biochemical tests and histological findings in the liver. Abnormal liver function tests warrant a liver biopsy, since the underlying liver disease influences the subsequent prognosis and treatment.Publishers' versio
Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial
Meeting abstract FRAB0101LB from 21st International AIDS Conference 18â22 July 2016, Durban, South Africa.
Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIVâinfected adults and children with advanced disease in subâSaharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown.
Methods:
The REALITY 2Ă2Ă2 factorial openâlabel trial (ISRCTN43622374) randomized ARTânaĂŻve HIVâinfected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (antiâtuberculosis) and fluconazole (antiâcryptococcal/candida), 5 days azithromycin (antiâbacterial/protozoal) and singleâdose albendazole (antiâhelminth)), versus standardâofâcare cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixedâdose combination. Two other randomizations investigated 12âweek adjunctive raltegravir or supplementary food. The primary endpoint was 24âweek mortality.
Results:
1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% lossâtoâfollowâup). Median baseline CD4 was 36 cells/mm3 (IQR: 16â62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54â0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58â0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2).
Conclusions:
Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIVâinfected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this lowâcost broad infection prevention package which could save 3.3 lives for every 100 individuals treated