Why have socio-economic explanations between favoured over cultural ones in explaining the intensive spread of HIV in South Africa?

The HIV prevalence in South Africa’s various racial/ethnic groups differs by more than an order of magnitude. These differences are determined not by the lifetime number of sexual partners, but by how these partnerships are more likely to be arranged concurrently in African communities. The available evidence demonstrates that neither HIV nor concurrency rates are determined by socio-economic factors. Rather, high concurrency rates are maintained by a culturally sanctioned tolerance of concurrency. Why then do socio-economicexplanations trump cultural ones in the South African HIV aetiological literature? In this article, we explore how three factors (a belief in monogamy as a universal norm, HIV’s emergence in a time of the construction of non-racialism, and a simplified understanding of HIV epidemiology) have intersected to produce this bias and therefore continue to hinder the country’s HIV prevention efforts

Cardiovascular risk factors in a treatment-naïve, human immunodeficiency virus-infected rural population in Dikgale, South Africa

Objective: The objective was to determine lipid levels and cardiovascular risk factors in treatment-naïve, humanimmunodeficiency virus (HIV)-infected rural African people in Limpopo province.Design: This was a case control study.Setting and subjects: The setting was Dikgale Health and Demographic Surveillance System Centre, Limpopo province. Treatment naïve, HIV-infected and HIV-negative people participated in the study.Outcome measures: Demographic, lifestyle and chronic disease data were collected using the World Health Organization stepwise approach to surveillance (STEPS) questionnaire. Biochemical parameters were tested using standard biochemical methods. HIV testing and CD4 counts were performed using the Alere Determine™ HIV 1/2 Ag/Ab kit and The Alere Pima™ Analyser. Insulin resistance, low-density lipoprotein cholesterol (LDL cholesterol), and non-high-density lipoprotein cholesterol (non-HDL cholesterol) levels were calculated.Results: The mean age of participants (years) was 49.7 ± 16.6. More HIV-infected than HIV-uninfected women consumed alcohol (25.4% vs. 11.9%, p-value < 0.05), and the prevalence of abdominal obesity was higher in HIV-uninfected than in HIV-infected women (74.6% vs. 54.8%, p-value < 0.05). Levels of total cholesterol (TC), HDL cholesterol, non-HDL cholesterol, LDL cholesterol and apolipoprotein A1 (ApoA1) were significantly lower in the HIV-infected than in the HIV-uninfected group. The prevalence of low HDL cholesterol was higher in HIV-infected than in HIV-uninfected people (62.4% vs. 41.6%, p-value < 0.01). HIV infection increased the likelihood of low HDL cholesterol by 2.7 times (p-value 0.001). Male gender and alcohol use decreased the likelihood of low HDL cholesterol by 61% (p-value 0.002) and 48% (p-value 0.048), respectively. HIV infection was associated with low HDL cholesterol, ApoA1, LDL cholesterol and TC. Low CD4 count was associated with low body mass index, LDL cholesterol and high diastolic blood pressure.Conclusion: The prevalence of cardiovascular risk factors was equally high in HIV-infected and in HIV-uninfected rural people, except for low HDL and alcohol consumption, which were significantly higher in HIV-infected people, while abdominal obesity was significantly higher in HIV-uninfected people. There is a need to raise awareness of cardiovascular risk factors in rural people in Limpopo province.Keywords: abdominal obesity, alcohol, diabetes, hypertension, lipid

Viewpoint: filovirus haemorrhagic fever outbreaks: much ado about nothing?

The recent outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo has put the filovirus threat back on the international health agenda. This paper gives an overview of Marburg and Ebola outbreaks so far observed and puts them in a public health perspective. Damage on the local level has been devastating at times, but was marginal on the international level despite the considerable media attention these outbreaks received. The potential hazard of outbreaks, however, after export of filovirus from its natural environment into metropolitan areas, is argued to be considerable. Some avenues for future research and intervention are explored. Beyond the obvious need to find the reservoir and study the natural history, public health strategies for a more timely and efficient response are urgently needed

Regional and temporal changes in AIDS in Europe before HAART

In a prospective observational study 4485 patients from 46 clinical centres in 17 European countries were followed between April 1994 and November 1996. Information on AIDS-defining events (ADEs) were collected together with basic demographic data, treatment history and laboratory results. The centres were divided into four geographical regions (north, central, south-west and south-east) so that it was possible to identify any existing regional differences in ADEs. The regional differences that we observed included a higher risk of all forms of Mycobacterium tuberculosis infections (Tb) and wasting disease in the south-west and an increased risk of infections with the Mycobacterium avium complex (MAC) in the north. In Cox multivariable analyses, where north was used as the reference group, we observed hazard ratios of 6.87, 7.77, 2.29 and 0.16 (P < 0.05 in all cases) for pulmonary Tb, extrapulmonary Tb, wasting disease and MAC respectively in the south-west. Pneumocystis carinii pneumonia (PCP) was less commonly diagnosed in the central region (RH = 0.51, 95% CI 0.32-0.79, P = 0.003) and most common in the south-east (RH = 1.04, 95% CI 0.71-1.51, P = 0.85). Comparisons with a similar 'AIDS in Europe' study that concentrated on the early phase of the epidemic reveal that most of the regional differences that were observed in the 1980s still persist in the mid-1990s

Organisation of Health Care During an Outbreak of Marburg Haemorrhagic Fever in the Democratic Republic of Congo, 1999.

Organising health care was one of the tasks of the International Scientific and Technical Committee during the 1998-1999 outbreak in Durba/Watsa, in the north-eastern province (Province Orientale), Democratic Republic of Congo. With the logistical support of Médecins sans Frontières (MSF), two isolation units were created: one at the Durba Reference Health Centre and the other at the Okimo Hospital in Watsa. Between May 6th, the day the isolation unit was installed and May 19th, 15 patients were admitted to the Durba Health Centre. In only four of them were the diagnosis of Marburg haemorrhagic fever (MHF) confirmed by laboratory examination. Protective equipment was distributed to health care workers and family members caring for patients. Information about MHF, modes of transmission and the use of barrier nursing techniques was provided to health care workers and sterilisation procedures were reviewed. In contrast to Ebola outbreaks, there was little panic among health care workers and the general public in Durba and all health services remained operational

Migration intensity has no effect on peak HIV prevalence: An ecological study

Background: Correctly identifying the determinants of generalized HIV epidemics is crucial to bringing down ongoing high HIV incidence in these countries. High rates of migration are believed to be an important determinant of HIV prevalence. This study has two aims. Firstly, it evaluates the ecological association between levels of internal and international migration and national peak HIV prevalence using thirteen variables from a variety of sources to capture various aspects of internal and international migration intensity. Secondly, it examines the relationship between circular migration and HIV at an individual and population-level in South Africa.Methods: Linear regression was used to analyze the association between the various measures of migration intensity and peak national HIV prevalence for 141 countries and HIV prevalence by province and ethnic group in South Africa.Results: No evidence of a positive ecological association between national migration intensity and HIV prevalence was found. This remained the case when the analyses were limited to the countries of sub-Saharan Africa. On the whole, countries with generalized HIV epidemics had lower rates of internal and external migration. Likewise, no association was found between migration and HIV positivity at an individual or group-level in South Africa.Conclusion: These results do not support the thesis that migration measured at the country level plays a significant role in determining peak HIV prevalence

High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo

Background: An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake of Ivermectin was associated with a lower prevalence of epilepsy. Methodology/Principle findings: Between July 2014 and February 2016, house-to-house epilepsy prevalence surveys were carried out in areas with a high level of onchocerciasis endemicity: 3 localities in the Bas-Uele, 24 in the Tshopo and 21 in the Ituri province. Ivermectin uptake was recorded for every household member. This database allowed a matched case-control pair subset to be created that enabled putative risk factors for epilepsy to be tested using univariate logistic regression models. Risk factors relating to onchocerciasis were tested using a multivariate random effects model. To identify presence of clusters of epilepsy cases, the Kulldorff's scan statistic was used. Of 12, 408 people examined in the different health areas 407 (3.3%) were found to have a history of epilepsy. A high prevalence of epilepsy was observed in health areas in the 3 provinces: 6.8–8.5% in Bas-Uele, 0.8–7.4% in Tshopo and 3.6–6.2% in Ituri. Median age of epilepsy onset was 9 years, and the modal age 12 years. The case control analysis demonstrated that before the appearance of epilepsy, compared to the same life period in controls, persons with epilepsy were around two times less likely (OR: 0.52; 95%CI: (0.28, 0.98)) to have taken Ivermectin than controls. After the appearance of epilepsy, there was no difference of Ivermectin intake between cases and controls. Only in Ituri, a significant cluster (p-value = 0.0001) was identified located around the Draju sample site area. Conclusions: The prevalence of epilepsy in health areas in onchocerciasis endemic regions in the DRC was 2–10 times higher than in non-onchocerciasis endemic regions in Africa. Our data suggests that Ivermectin protects against epilepsy in an onchocerciasis endemic region. However, a prospective population based intervention study is needed to confirm this

Neutrophil activation and enhanced release of granule products in HIV-TB immune reconstitution inflammatory syndrome

Background: Tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) remains incompletely understood. Neutrophils are implicated in tuberculosis pathology but detailed investigations in TB-IRIS are lacking. We sought to further explore the biology of TB-IRIS and, in particular, the role of neutrophils. Setting: Two observational, prospective cohort studies in HIV/TB coinfected patients starting antiretroviral therapy (ART), 1 to analyze gene expression and subsequently 1 to explore neutrophil biology. Methods: nCounter gene expression analysis was performed in patients with TB-IRIS (n = 17) versus antiretroviral-treated HIV/TB coinfected controls without IRIS (n = 17) in Kampala, Uganda. Flow cytometry was performed in patients with TB-IRIS (n = 18) and controls (n = 11) in Cape Town, South Africa to determine expression of neutrophil surface activation markers, intracellular cytokines, and human neutrophil peptides (HNPs). Plasma neutrophil elastase and HNP1-3 were quantified using enzyme-linked immunosorbent assay. Lymph node immunohistochemistry was performed on 3 further patients with TB-IRIS. Results: There was a significant increase in gene expression of S100A9 (P = 0.002), NLRP12 (P = 0.018), COX-1 (P = 0.025), and IL-10 (P = 0.045) 2 weeks after ART initiation in Ugandan patients with TB-IRIS versus controls, implicating neutrophil recruitment. Patients with IRIS in both cohorts demonstrated increases in blood neutrophil count, plasma HNP and elastase concentrations from ART initiation to week 2. CD62L (L-selectin) expression on neutrophils increased over 4 weeks in South African controls whereas patients with IRIS demonstrated the opposite. Intense staining for the neutrophil marker CD15 and IL-10 was seen in necrotic areas of the lymph nodes of the patients with TB-IRIS. Conclusions: Neutrophils in TB-IRIS are activated, recruited to sites of disease, and release granule contents, contributing to pathology

Evaluation of Clinical and Immunological Markers for predicting Virological Failure in a HIV/AIDS treatment cohort in Busia, Kenya

In resource-limited settings where viral load (VL) monitoring is scarce or unavailable, clinicians must use immunological and clinical criteria to define HIV virological treatment failure. This study examined the performance of World Health Organization (WHO) clinical and immunological failure criteria in predicting virological failure in HIV patients receiving antiretroviral therapy (ART)

Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect