Appraisal of the inherent socio-demographic dynamics of HIV/AIDS epidemic in four districts of South-Western Uganda

Although HIV prevalence in Uganda is much lower than it once was, AIDS is still claiming many lives each year with clear signs of escalating rural epidemics. The objective of this study was to appraise the socio-economic and demographic dynamics of HIV/AIDS epidemic in South-Western Uganda. Data were collected with standard closed ended semi-structured questionnaires self-administered to consenting, 605 HIV/AIDS patients, selected using the multistage random sampling technique, logistic linear regression, randomized block design and Pearson’s Chi square test (á=0.01) were used to analyse the data obtained. The duration of carriage was inversely proportional (r=-0.94) to population of HIV/AIDS patients surveyed. There were 98.2% Bantu (55.5% Banyankole and 22.6% Baganda); 77.5% females and 22.5% males; more widows (38.0%) than married (35.5%). HIV/AIDS prevalence generally decreased with increasinglevel of education. The highest (66.7%) HIV/AIDS prevalence was recorded in Bushenyi, followed by 58.4% in Masaka, 57.9% in Mbarara and 53.3% in Rukungiri. Rukungiri patients above 60 years of age harboured 57.1% HIV/AIDS followed by 45.5% among Masaka patients aged 11 - 20 years and 40% among Mbarara patients less than 10 years of age. HIV/AIDS prevalence was significantly (p<0.05) dependent on socio-economic and demographic factors of surveyed population. Therefore socio-economic and demographic factors underlie HIV/AIDS prevalence in this region. Observed differences in prevalence of HIV/AIDS between the surveyed districts wereremarkable and warrant regular surveillance for updated disease  epidemiology. Education can debunk the generally misconstrued rolesof social, economic and demographic factors in the spread of HIV/AIDS

Lymphoid tissue fibrosis is associated with impaired vaccine responses

Vaccine responses vary by geographic location. We have previously described how HIV-associated inflammation leads to fibrosis of secondary lymph nodes (LNs) and T cell depletion. We hypothesized that other infections may cause LN inflammation and fibrosis, in a process similar to that seen in HIV infection, which may lead to T cell depletion and affect vaccine responses. We studied LNs of individuals from Kampala, Uganda, before and after yellow fever vaccination (YFV) and found fibrosis in LNs that was similar to that seen in HIV infection. We found blunted antibody responses to YFV that correlated to the amount of LN fibrosis and loss of T cells, including T follicular helper cells. These data suggest that LN fibrosis is not limited to HIV infection and may be associated with impaired immunologic responses to vaccines. This may have an impact on vaccine development, especially for infectious diseases prevalent in the developing world

Translocated microbiome composition determines immunological outcome in treated HIV infection

The impact of the microbiome on HIV disease is widely acknowledged although the mechanisms downstream of fluctuations in microbial composition remain speculative. We detected rapid, dynamic changes in translocated microbial constituents during two years after cART initiation. An unbiased systems biology approach revealed two distinct pathways driven by changes in the abundance ratio of Serratia to other bacterial genera. Increased CD4 T cell numbers over the first year were associated with high Serratia abundance, pro-inflammatory innate cytokines, and metabolites that drive Th17 gene expression signatures and restoration of mucosal integrity. Subsequently, decreased Serratia abundance and downregulation of innate cytokines allowed re-establishment of systemic T cell homeostasis promoting restoration of Th1 and Th2 gene expression signatures. Analyses of three other geographically distinct cohorts of treated HIV infection established a more generalized principle that changes in diversity and composition of translocated microbial species influence systemic inflammation and consequently CD4 T cell recovery. [Display omitted] •Ratio of Serratia to other bacterial genera changes rapidly over time after ART•High ratio at year one drives inflammation and first wave of immune reconstitution•Diversity & distinct microbial ratio at year two is associated with reconstitution•Microbial diversity and composition drive reconstitution in diverse HIV cohorts Longitudinal high-dimensional analysis of translocated microbial products in the plasma of HIV+ individuals treated with combined antiretroviral therapy reveals dynamic changes in plasma cytokines and immune cell subsets, resulting in two distinct waves of immune reconstitution that lead to CD4+ T cell recovery