HIV-1 Seroconversion Incidence Following Pregnancy and Delivery Among Women Seronegative at Recruitment in Harare, Zimbabwe

A CAJM article on the incidence of HIV amongst pregnant women in Zimbabwe.Objective: To estimate the incidence of HIV sero-conversion among women following pregnancy and' delivery. Design: A prospective cohort of women who were HIV negative at recruitment on first antenatal care visit. Materials and Methods: Pregnant women were invited to undergo voluntary confidential HIV counseling and blood draw for HIV testing during the first antenatal care visit as part of a prospective study of mother- to-child transmission of HIV-1. Repeat tests were conducted at delivery, six weeks post partum and at three monthly intervals until 24 months or on termination due to subsequent pregnancy, death or loss to follow up. Logistic regression modelling was used to determine independent predictors of HIV sero-conversion. Results: Among 372 HIV negative pregnant women who were enrolled, 66 sero-converted during follow up, resulting in a sero-incidence of 4.8 per 100 person years (95% confidence interval [Cl], 3.1 to 6.5). Women who did not seroconvert during the time of pregnancy or follow up were significantly more likely to have used a condom with their partners (OR = 0.68,95% Cl = 0.47 to 0.99). Women aged 17 years and below had the highest sero-conversion incidence (6.25%) followed by those aged 18 to 19 years (5.42%). Women who sero-converted and those who were HIV positive at recruitment were more likely to be married. Lack of education by the partner of a pregnant woman constituted a significant risk factor for HIV sero-conversion (OR = 2.8; 95% Cl = 1.1 toll.0). Conclusions: There is a high HIV sero-conversion incidence among women during pregnancy and following delivery, especially those aged 19 years and below. Being married does not protect the women from the risk of HIV sero-conversion. Strategies for HIV prevention should target pregnant women and their partners

Investigating the control of manganese sulphide precipitation

The generation and control of manganese sulphide particle size distribution using various mixing configurations were investigated. Specifically, this paper discusses how varying mixing intensities on a macro and micro scale affect the resultant manganese sulphide particle size distribution (PSD) at a constant concentration. The mixing variations were achieved using various Y- and T-mixers as premixing devices into a jacketed, agitated vessel. The reagents used to generate the seeds were aqueous manganese sulphate and sodium sulphide solutions. The results showed that the absence of micromixing resulted in very poor control of the particle size distribution, the particle size and the number of particles produced. This was due to the fact that the macromixing time is much greater than the corresponding precipitation time, resulting in different mixing regions existing within the reactor. From the micromixing experiments, the T–mixer was found to be the most effective mixing device at lower concentrations due to the T-mixer providing a faster mixing time than the other mixing configurations, thereby effectively localizing the supersaturation and hence controlling the precipitation. The results obtained from the direct addition without the extension pipe (i.e. short mixing time) indicated a general increase in mean particle size and decrease in total particle number at reagent concentration of 0.007 mol.dm-3 as compared to the corresponding micromixing experiments. The phenomenon may be due to incomplete crystallization at the immediate exit of the mixing device. Further experiments need to be conducted before any conclusions can be drawn about the precipitation mechanisms

Cardiac Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection

Background. At least one-third of human immunodeficiency virus (HIV)–infected infants survive to adolescence even without antiretroviral therapy (ART), but are at high risk of complications including cardiac disease. We investigated the characteristics of cardiac disease among adolescents with HIV infection diagnosed in late childhood who were receiving ambulatory HIV care in Harare, Zimbabwe. / Methods. Consecutive adolescents with vertically acquired HIV attending 2 HIV outpatient treatment clinics were studied. Assessment included clinical history and examination, and 2-dimensional, M-mode, pulsed- and continuous-wave Doppler echocardiography. / Results. Of 110 participants (47% male; median age, 15 years; interquartile range, 12–17 years), 78 (71%) were taking ART. Exertional dyspnea, chest pain, palpitations, and ankle swelling were reported by 47 (43%), 43 (39%), 10 (9%), and 7 (6%), respectively. The New York Heart Association score was ≥2 in 41 participants (37%). Echocardiography showed that 74 participants (67%) had left ventricular (LV; septal and/or free wall) hypertrophy and 27 (24%) had evidence of impaired LV relaxation or restrictive LV physiology. The estimated pulmonary artery systolic pressure (ePASP) was >30 mm Hg in 4 participants (3.6%); of these 2 also had right ventricular (RV) dilatation. Another 32 participants (29%), without elevated ePASP, had isolated RV dilatation. / Conclusions. A significant burden of cardiac disease was seen among adolescents with vertically acquired HIV infection. More than half were asymptomatic yet had significant echocardiographic abnormalities. These findings highlight the need to screen this population in order to better define the geography, natural history, etiopathogenic mechanisms, and management (including the timing and choice of optimal therapeutic ART and cardiac drug interventions) to prevent development and/or progression of HIV-associated cardiac disease

Chronic lung disease in HIV-infected children established on antiretroviral therapy.

Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function, and exercise capacity among older children established on ART, and an age-matched HIV-uninfected group. A cross-sectional study in Zimbabwe of: 1) HIV-infected children aged 6-16 years receiving ART for over six months; 2) HIV-uninfected children attending primary health clinics from the same area. Standardised questionnaire, spirometry, Incremental Shuttle Walk Testing (ISWT), CD4 count, HIV viral load, and sputum culture for tuberculosis were performed. 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (IQR 2.8-7.5) and 6.1 years (IQR 3.6-8.4) respectively. Median CD4 count was 726 cells/μl, and 79% had HIV viral load<400copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children (n = 1 [0.7%]), but common in HIV-infected participants (51 [25%]), especially cough (30 [15%]) and dyspnoea (30 [15%]). HIV-infected participants were more commonly previously treated for tuberculosis (76 [38%] versus 1 [0.7%], p < 0.001), had lower exercise capacity (mean ISWT distance 771m versus 889m respectively, p < 0.001), and more frequently abnormal spirometry (43 [24.3%] versus 15 [11.5%], p = 0.003) compared to HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (p = 0.025). No participant tested positive for M. tuberculosis. In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required

Group B Streptococcus and HIV Infection in Pregnant Women, Malawi, 2008–2010

To determine whether an association exists between group B streptococcus carriage and HIV infection, we recruited 1,857 pregnant women (21.7% HIV positive) from Queen Elizabeth Central Hospital, Blantyre, Malawi. Overall, group B streptococcus carriage was 21.2% and did not differ by HIV status. However, carriage was increased among HIV-positive women with higher CD4 counts

Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study

Objectives To estimate the rates and timing of mother to infant transmission of HIV associated with breast feeding in mothers who seroconvert postnatally, and their breast milk and plasma HIV loads during and following seroconversion, compared with women who tested HIV positive at delivery

Internet-based medical education: a realist review of what works, for whom and in what circumstances

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Inflammation and epithelial repair predict mortality, hospital readmission, and growth recovery in complicated severe acute malnutrition.

Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM is a multisystem disease with high inpatient and postdischarge mortality, especially in children with comorbidities such as HIV; however, the underlying pathogenesis of complicated SAM is poorly understood. Targeted multiplex biomarker analysis in children hospitalized with SAM (n = 264) was conducted on plasma samples, and inflammatory markers were assessed on stool samples taken at recruitment, discharge, and 12 to 24 and 48 weeks after discharge from three hospitals in Zimbabwe and Zambia. Compared with adequately nourished controls (n = 173), we found that at baseline, complicated SAM was characterized by systemic, endothelial, and intestinal inflammation, which was exacerbated by HIV infection. This persisted over 48 weeks despite nutritional recovery and was associated with children's outcomes. Baseline plasma concentrations of vascular endothelial growth factor, glucagon-like peptide-2, and intestinal fatty acid-binding protein were independently associated with lower mortality or hospital readmission over the following 48 weeks. Following principal components analysis of baseline biomarkers, higher scores of a component representing growth factors was associated with greater weight-for-height z score recovery and lower mortality or hospital readmission over the 48 weeks. Conversely, components representing higher gut and systemic inflammation were associated with higher mortality or hospital readmission. These findings highlight the interplay between inflammation, which damages tissues, and growth factors, which mediate endothelial and epithelial regeneration, and support further studies investigating interventions to reduce inflammation and promote epithelial repair as an approach to reducing mortality and improving nutritional recovery