Declines in Lung Function After Antiretroviral Therapy Initiation in Adults With Human Immunodeficiency Virus and Tuberculosis: A Potential Manifestation of Respiratory Immune Reconstitution Inflammatory Syndrome

End-organ impairment has received relatively little research attention as a possible manifestation of tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS). In this prospective cohort study, one-half of adults with human immunodeficiency virus and pulmonary tuberculosis experienced meaningful declines in lung function on antiretroviral therapy, suggesting a role for lung function in TB-IRIS definitions

Assessment of awareness, knowledge, attitude towards the human papillomavirus infection and vaccine acceptability among University of Johannesburg students

M.Tech. (Biomedical Technology)Abstract: Background: The Human Papillomavirus (HPV) is one of the most common types of sexually transmitted infections (STIs) in South Africa. Increasing evidence suggests that HPV is implicated in 99.7% of cervical cancer cases worldwide. In South Africa, the highest infection rates of HPV are found in sexually active women under the age of 25 years. The burden of cervical cancer is compounded by the high prevalence of human immunodeficiency virus (HIV) and a lack of a cervical screening programme. Risk factors include sexual debut at an early age, smoking, previous history of sexually transmitted infections (STIs) and multiple sexual partners. College students are often perceived as being at high risk due to peer pressure, which often leads to risky sexual behaviour. Given the high burden of HPV infection and cervical cancer deaths in South Africa, there is a need to educate and raise awareness of HPV infection and the HPV vaccine among young adults under the age of 25 years. This study was undertaken to assess the awareness, knowledge, attitude towards HPV and vaccine acceptability among the University of Johannesburg students. Methods: A cross-sectional survey involving 150 conveniently selected University of Johannesburg students was conducted from July to October 2017. The respondents were selected proportionally from each of the four campuses of the University of Johannesburg. A self-administered structured questionnaire was utilised to collect information on socio-demographic factors, sexual behaviour, awareness and knowledge of HPV infection as well the vaccine, the willingness to recommend HPV vaccine and preferred source of information about HPV. The Pearson Chi-square test or Fischer exact test were used comparative analysis between factors that influenced HPV awareness. Sociodemographic and behaviour characteristics of the respondents are presented in graphs, charts, frequencies, percentages and standard deviation. Logistic regression analysis was used to identify factors independently associated with being aware of HPV. Results: HPV awareness was poor, with 32.7% (49) of the students reported to have heard about HPV. Of these, 38 of the students knew that HPV is the cause of cervical cancer and 66 (44%) were aware that they could be easily infected with HPV. Only 18.7% of participants knew of the HPV vaccine and 33.3% of these knew that the vaccine protected against cervical cancer. Female participants were three times more likely to be aware of HPV (adjusted odds ratio [aOR]: 2.92; 95% CI: 1.09-7.84, p=..

Lung function and collagen 1a levels are associated with changes in 6 min walk test distance during treatment of TB among HIV-infected adults: a prospective cohort study

Abstract Background Patients with tuberculosis (TB) and HIV often present with impairments in lung function and exercise capacity after treatment. We evaluated clinical and immunologic variables associated with a minimum clinically important difference (MCID) in the change in the 6 min walk test distance during the first 24 weeks of antiretroviral (ART) and anti-tubercular therapy. Methods Adults initiating ART and anti-TB treatment in the setting of newly-diagnosed HIV and pulmonary TB were enrolled in a prospective cohort study in South Africa. Patients underwent 6 min walk tests and spirometry at weeks 0, 4, 12, and 24 and biomarker level measurements early during treatment, at weeks 0, 4, and 12, when inflammation levels are typically elevated. Biomarkers included matrix metalloproteinases-1 (MMP-1), tissue inhibitor of MMP (TIMP)-1, collagen 1a, IL-6, IL-8, vascular cell adhesion molecule 1 (VCAM-1), C-X-C motif chemokine 10 (CXCL-10), CXCL-11, macrophage colony-stimulating factor (M-CSF), plasminogen activator, vascular endothelial growth factor, and chemokine (C-C) motif-2 (CCL-2). An MCID was derived statistically, and achievement of an MCID was modeled as the outcome using logistic regression model. Results Eighty-nine patients walked an average of 393 (± standard deviation = 69) meters at baseline, which increased by an average of 9% (430 ± 70 m) at week 24. The MCID for change in walk distance was estimated as 41 m. Patients experiencing an MCID on treatment had worse lung function, lower 6 min walk test distance, higher levels of proinflammatory biomarkers including TIMP-1 and M-CSF, and lower levels of collagen 1a at baseline. Experiencing an MCID during treatment was associated with increases in forced expiratory volume in 1-s [odds ratio (OR) = 1.17, 95% confidence interval (CI) = 1.05–1.33] and increases in blood collagen 1a levels (OR = 1.31, 95%CI 1.06–1.62). Conclusions ART and TB treatment are associated with substantial improvements in 6 min walk test distance over time. Achievement of an MCID in the 6 min walk test in this study was associated with more severe disease at baseline and increases in collagen 1a levels and lung function during therapy