Post-natal incidence of HIV-1 infection among children in a rural Ugandan population: no evidence for transmission other than mother to child

We conducted a prospective cohort study to determine the post‐natal incidence of and possible transmission routes for HIV‐1 infection in rural Ugandan children. The cohort consisted of the population of a cluster of 15 villages in Masaka District, south‐west Uganda, and was enrolled in 1989–1990 through a demographic and serological survey. During the period 1991–1993 the population was resurveyed annually. A total of 5492 children aged 0–12 years were enrolled; of these, 41 (0.7%) were seropositive infants. A total of 3941 (72%) children were HIV‐negative on enrolment and had at least one follow‐up specimen. During 8596 person‐years of observation only 1 seroconversion was observed, an incidence rate of 0.12 (95% CI 0.00–0.35) per 1000 years of observation. The transmission of HIV was most probably through breast milk. The case corresponds to a rate of 1.1 per 1000 in households with one or more HIV‐positive adults (874 years of observation); no incident case was observed in households with only seronegative adults (6423 years of observation). Thus, HIV infection among children aged 0–12 years in this population is virtually exclusively the result of mother‐to‐child transmission. No infections were observed attributable to parenteral exposure, non‐sexual casual or household contact, or insects.     

A community randomized controlled trial to investigate impact of improved STD management and behavioural interventions on HIV incidence in rural Masaka,Uganda: trial design,methods and baseline findings

OBJECTIVE: To describe study design, methods and baseline findings of a behavioural intervention alone and in combination with improved management of sexually transmitted diseases (STDs) aimed at reducing HIV incidence and other STDs. DESIGN: A three-arm community randomized controlled trial (RCT) of 18 rural communities (approximately 96 000 adults) in SW Uganda. A standardized behavioural intervention was implemented in 12 communities (arms A and B) through community-based education, meetings and information leaflets. Six of these communities in addition received improved STD management through government and private health units (arm B). Arm C communities received routine government health services. Impact assessment was through three questionnaire and serological surveys of 750-1000 adults in each community at 18-24-month intervals. The primary outcome measure was HIV incidence and secondary measures were syphilis and herpes simplex virus type 2 incidence, prevalence of Neisseria gonorrhoea and Chlamydia trachomatis and sexual behaviour changes. RESULTS: Approximately 15 000 adults (72% of eligible population) were enrolled at baseline. HIV baseline prevalence rates were 9-10% in all arms and demographic and behavioural characteristics and STD prevalence were also similar. In intervention communities, there were 391 995 attendance at 81 502 activities (6.1 per target adult), 164 063 leaflets distributed (2.6 per person) and 1 586 270 condoms (16.5 condoms per adult). In the STD communities a total of 12 239 STD cases (65% women) were seen over a 5-year period (7.7 per 100 adults/year). CONCLUSION: This is the first community RCT of its type with a behavioural component. There is fair baseline comparability between study arms and process data suggest that interventions were adequately implemented.     

Determinants of the impact of sexually transmitted infection treatment on prevention of HIV infection: a synthesis of evidence from the Mwanza, Rakai, and Masaka intervention trials

Community-randomized trials in Mwanza, Tanzania, and Rakai and Masaka, Uganda, suggested that population characteristics were an important determinant of the impact of sexually transmitted infection (STI) treatment interventions on incidence of human immunodeficiency virus (HIV) infection. We performed simulation modeling of HIV and STI transmission, which confirmed that the low trial impact in Rakai and Masaka could be explained by low prevalences of curable STI resulting from lower-risk sexual behavior in Uganda. The mature HIV epidemics in Uganda, with most HIV transmission occurring outside core groups with high STI rates, also contributed to the low impact on HIV incidence. Simulated impact on HIV was much greater in Mwanza, although the observed impact was larger than predicted from STI reductions, suggesting that random error also may have played some role. Of proposed alternative explanations, increasing herpetic ulceration due to HIV-related immunosuppression contributed little to the diminishing impact of antibiotic treatment during the Ugandan epidemics. The strategy of STI treatment also was unimportant, since syndromic treatment and annual mass treatment showed similar effectiveness in simulations of each trial population. In conclusion, lower-risk behavior and the mature HIV epidemic explain the limited impact of STI treatment on HIV incidence in Uganda in the 1990s. In populations with high-risk sexual behavior and high STI rates, STIs treatment interventions may contribute substantially to prevention of HIV infection.     

A comparison of clinical findings of familial Mediterranean fever patients with and without amyloidosis

Objective This study investigates the clinical and demographic characteristics of familial Mediterranean fever (FMF) patients with and without amyloidosis.Patients and methods The clinical data of 503 patients with FMF (females:males 250:253) were reviewed. Fifty of these patients had amyloidosis (f:m 23:27).Results The ages of attack onset in patients with and without amyloidosis were 7.8±6.2 and 11.1±8.5, respectively (P<0.05). The time between disease onset and diagnosis was longer in patients with amyloidosis than those without (187.6±99.4 months and 132.5±110.2 months, respectively, P<0.001). More patients in the amyloidosis group had positive family histories of FMF (68% vs 54%, P<0.05). The frequencies of chest pain (78% vs 51%, P<0.001), arthritis ( 80% vs 60%, P<0.01), and erysipelas-like erythema (44% vs 16%, P<0.001) were higher in the amyloidosis group.Conclusion In the amyloidosis group, FMF-related manifestations of chest pain, arthritis, and erysipelas-like erythema are more frequent. Our results also support that long periods between disease onset and diagnosis are associated with a high risk of developing amyloidosis.     

Effects of renal transplantation on serum-free and total PSA levels

PURPOSE: This study was undertaken to evaluate the effects of renal transplantation on serum level of free and total PSA. MATERIALS AND METHODS: In this study, we included 30 male patients with a mean age of 46 years with end-stage renal disease undergoing renal transplantation at our department. None of the patients had any history of prostate cancer. All patients had immediate onset of renal function after transplantation, defined by a spontaneous decrease in serum creatinine on postoperative day 1 and a subsequent decrease daily during week 1. Renal transplantation included living-related donors in all patients. Blood samples were obtained before and at posttransplant day 6 before removal of Foley catheter. Measurements of free PSA and total PSA were performed with immunofluorometric assays. Glomerular filtration rates were monitored by analyzing serum creatinine. The significance of changes with time was estimated by the Wilcoxon signed ranks test for paired observations with P<.05 considered statistically significant. RESULTS: The mean free and total PSA levels before transplantation were 0.22 (range, 0.0.05 to 0.4) and 1.5 ng/mL (range, 0.1 to 2.9), respectively. There was a significant decrease (30% of original levels) in serum fPSA at posttransplant day 6 (P<.05) in all patients. There was no significant changes of total PSA at posttransplant day 6. CONCLUSIONS: These results verify the hypothesis that free PSA is eliminated from the blood circulation by glomerular filtration and severe renal failure influences its levels. Thus, we should consider different cutoffs for free to total ratio before and after renal transplantation.     

Lifetime history of substance misuse in first-episode psychosis: prevalence and its influence on psychopathology and onset of psychotic symptoms

Introduction: Substance misuse (SM) (drug/alcohol dependence or abuse) in psychotic illness is an increasingly recognized problem. We aimed to estimate the prevalence and examine the influence of SM on age at onset of psychosis and psychopathology among patients with first‐episode psychosis. Method: One hundred seventy‐one consecutive patients with first‐episode psychosis were assessed. SM, age of onset of psychosis and psychopathology were determined using valid instruments. Results: Seventy‐seven (46%) patients had a lifetime history of SM and were predominately males, had more positive symptoms, and in the majority of cases (84%), started misusing substances before the onset of psychosis (SM‐BP). There was no difference in age of onset between patients with SM‐BP and the rest of the sample. Conclusion: Lifetime history of SM is common and may influence psychopathology, but does not appear to influence or bring forward the age at onset of psychotic symptoms.     

Diabetes mellitus aggravates ranolazine-induced ECG changes in rats

Journal of Interventional Cardiac Electrophysiology - Diabetes mellitus (DM) is known to affect the pharmacokinetics of drugs. In this study, we evaluated the effect of DM on the liver content of...