The epidemiological impact of an HIV vaccine on the HIV/AIDS epidemic in Southern India

The potential epidemiological impact of preventive HIV vaccines on the HIV epidemic in Southern India is examined using a mathematical deterministic dynamic compartmental model. Various assumptions about the degree of protection offered by such a vaccine, the extent of immunological response of those vaccinated, and the duration of protection afforded are explored. Alternative targeting strategies for HIV vaccination are simulated and compared with the impact of conventional prevention interventions in high-risk groups and the general population. The impact of disinhibition (increased risk behavior due to the presence of a vaccine) is also considered. Vaccines that convey a high degree of protection in a share of or all of those immunized and that convey life-long immunity are the most effective in curbing the HIV epidemic. Vaccines that convey less than complete protection may also have substantial public health impact, but disinhibition can easily undo their effects and they should be used combined with conventional prevention efforts. Conventional interventions that target commercial sex workers and their clients to increase condom use can also be highly effective and can be implemented immediately, before the arrival of vaccines.Poverty and Health,Disease Control&Prevention,Health Monitoring&Evaluation,Public Health Promotion,HIV AIDS,HIV AIDS,Health Monitoring&Evaluation,Adolescent Health,HIV AIDS and Business,Health Service Management and Delivery

Tuberculosis and sexually transmitted infections

To the Editor: Mycobacterium tuberculosis infection is a necessary, but not sufficient, cause of tuberculosis (TB). Infection with HIV is the strongest known risk factor for disease progression to TB. In the absence of HIV infection, disease develops in 5% to 15% of infected persons. Unfortunately, the process of progression to disease is poorly understood. We hypothesize that, in addition to HIV, another sexually transmitted infection (STI) also increases such disease progression. Identification of this STI might suggest new approaches to disease control.Several associations between the risk for TB and lifestyle factors have been identified. [...]<br/

Tuberculosis and sexually transmitted infections

To the Editor: Mycobacterium tuberculosis infection is a necessary, but not sufficient, cause of tuberculosis (TB). Infection with HIV is the strongest known risk factor for disease progression to TB. In the absence of HIV infection, disease develops in 5% to 15% of infected persons. Unfortunately, the process of progression to disease is poorly understood. We hypothesize that, in addition to HIV, another sexually transmitted infection (STI) also increases such disease progression. Identification of this STI might suggest new approaches to disease control.Several associations between the risk for TB and lifestyle factors have been identified. [...]<br/

Tuberculosis and Sexually Transmitted Infections

To the Editor: Mycobacterium tuberculosis infection is a necessary, but not sufficient, cause of tuberculosis (TB). Infection with HIV is the strongest known risk factor for disease progression to TB. In the absence of HIV infection, disease develops in 5% to 15% of infected persons. Unfortunately, the process of progression to disease is poorly understood. We hypothesize that, in addition to HIV, another sexually transmitted infection (STI) also increases such disease progression. Identification of this STI might suggest new approaches to disease control.Several associations between the risk for TB and lifestyle factors have been identified. [...]<br/

Validation of Syndromic Surveillance for Respiratory Pathogen Activity

The studied respiratory syndromes are suitable for syndromic surveillance because they reflect respiratory pathogen activity pattern

Modelling HIV/AIDS epidemics in Botswana and India: impact of interventions to prevent transmission

OBJECTIVE: To describe a dynamic compartmental simulation model for Botswana and India, developed to identify the best strategies for preventing spread of HIV/AIDS. METHODS: The following interventions were considered: a behavioural intervention focused on female sex workers; a conventional programme for the treatment of sexually transmitted infections; a programme for the prevention of mother-to-child transmission; an antiretroviral treatment programme for the entire population, based on a single regimen; and an antiretroviral treatment programme for sex workers only, also based on a single regimen. FINDINGS: The interventions directed at sex workers as well as those dealing with sexually transmitted infections showed promise for long-term prevention of human immunodeficiency virus (HIV) infection, although their relative ranking was uncertain. In India, a sex worker intervention would drive the epidemic to extinction. In Botswana none of the interventions alone would achieve this, although the prevalence of HIV would be reduced by almost 50%. Mother-to-child transmission programmes could reduce HIV transmission to infants, but would have no impact on the epidemic itself. In the long run, interventions targeting sexual transmission would be even more effective in reducing the number of HIV-infected children than mother-to-child transmission programmes. Antiretroviral therapy would prevent transmission in the short term, but eventually its effects would wane because of the development of drug resistance. CONCLUSION: Depending on the country and how the antiretroviral therapy was targeted, 25-100% of HIV cases would be drug- resistant after 30 years of use