Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents.

SETTING: Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV. OBJECTIVES: To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents' perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months' post-HIV diagnosis. DESIGN: We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes). RESULTS: Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers. CONCLUSION: This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.

CONTEXTE: Les enfants et les adolescents séropositifs rencontrent des difficultés dans l'initiation et l'adhésion à la thérapie antirétrovirale (TAR). Des agents de santé communautaires (CHW) ont mis en place une intervention de soutien communautaire sous forme de visites structurées à domicile visant à améliorer l'initiation, l'adhésion et le traitement, auprès d'enfants et d'adolescents nouvellement diagnostiqués séropositifs. OBJECTIFS: 1) Décrire la mise en œuvre de l'intervention, 2) explorer les perceptions de l'intervention par les CHW, les soignants et les adolescents, 3) identifier les obstacles et les facilitateurs de la mise en œuvre, et 4) vérifier les résultats du traitement 12 mois après le diagnostic du VIH. METHODES: Nous nous sommes appuyés sur 1) des entretiens semi-structurés (n = 22) avec 5 adolescents, 11 soignants et 6 CHW, 2) 28 manuels de terrain des CHW, et 3) des données quantitatives sur les participants à l'étude (informations démographiques et résultats cliniques du VIH). RÉSULTATS: Quarante et un enfants ont reçu au moins une partie de l'intervention. Parmi ceux dont la charge virale a été testée, 26 (n = 32 ; 81,3%) étaient sous suppression virale. Les personnes interrogées ont estimé que l'intervention soutenait l'adhésion au TAR et renforçait la santé mentale. Les facilitateurs de la mise en œuvre de l'intervention étaient la commodité et les rapports entre les CHW et les familles. La stigmatisation, les difficultés à trouver des participants et les ressources inadéquates pour les CHW étaient des obstacles. CONCLUSION: Cette intervention a été utile pour soutenir l'adhésion au traitement du VIH chez les adolescents et les enfants. Les facilitateurs et les obstacles peuvent être utiles pour développer de futures interventions.

Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa.

BACKGROUND: Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of 'asthma' defined by symptoms is high compared to 'doctor diagnosed asthma'. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? METHODS: The Arksey and O'Malley's framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The 'Preview, Question, Read, Summarise' system was used and a narrative report was used to summarise the findings. RESULTS: A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. CONCLUSION: This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis.

Is Socio-Economic Status a Determinant of HIV-Related Stigma Attitudes in Zimbabwe? Findings from Project Accept.

HIV related stigma and discrimination is a known barrier for HIV prevention and care. We aimed to assess the relationship between socio-economic status (SES) and HIV related stigma in Zimbabwe. This paper uses data from Project Accept, which examined the impact of community-based voluntary counseling and testing intervention on HIV incidence and stigma. Total of 2522 eligible participants responded to a psychometric assessment tool, which assessed HIV related stigma and discrimination attitudes on 4 point Likert scale. The tool measured three components of HIV-related stigma: shame, blame and social isolation, perceived discrimination, and equity. Participants' ownership of basic assets was used to assess the socio-economic status. Shame, blame and social isolation component of HIV related stigma was found to be significantly associated with medium [odds ratio (OR)=1.73, P<0.01] and low SES (OR=1.97, P<0.01), indicating more stigmatizing attitudes by participants belonging to medium and low SES in comparison to high SES. For HIV related stigma and discrimination programs to be effective, they should take into account the socio-economic context of target population.

Natural clinical tolerance to peanut in African patients is caused by poor allergenic activity of peanut IgE.

BACKGROUND: In Africa, peanuts are frequently consumed, but severe allergic reactions are rare. We investigated immunological patterns of clinical tolerance to peanut in peanut-sensitized but asymptomatic patients from central Africa compared to peanut-allergic and peanut-sensitized but asymptomatic patients from Sweden. METHODS: Sera from allergic patients (n = 54) from Zimbabwe sensitized to peanut but without allergic symptoms to peanut, and sera from peanut-allergic (n = 25) and peanut-sensitized but asymptomatic (n = 25) patients from Sweden were analyzed toward peanut allergen components (Ara h 1-3, 6, 8-9) and other allergen molecules from important allergen sources using microarray. IgE to Ara h 2 peptide epitopes was analyzed, and allergenic activity was assessed by basophil activation assay. RESULTS: Forty-six percent of the African and all peanut-allergic Swedish patients showed IgE toward one of the highly allergenic peanut allergens (Ara h 1-3, 6, 9). However, 48% of the African patients had IgE to cross-reactive carbohydrate determinants (CCDs) with low allergenic activity and 60% of the Swedish asymptomatic patients had IgE against the PR protein Ara h 8. IgG and IgG4 specificities and levels could not discriminate between the African asymptomatic and Swedish peanut-allergic patients. Asymptomatic patients almost lacked IgE to Ara h 2 peptides, which were recognized by peanut-allergic patients. Peanut IgE from peanut asymptomatic patients showed poor allergenic activity compared with IgE from peanut-allergic patients. CONCLUSIONS: Natural clinical tolerance to peanut in the African patients can be caused by IgE to low allergenic peanut components and by poor allergenic activity of peanut-specific IgE.

Ocular surface squamous neoplasia (OSSN) and human immunodeficiency virus at Sekuru Kaguvi Eye Unit in Zimbabwe: the role of operational research studies in a resource poor environment?

OBJECTIVE: To determine the extent of association and relative risk of developing ocular surface squamous neoplasia (OSSN) among HIV positive patients seen in July 2004 at Sekuru Kaguvi Eye Unit, in Harare, Zimbabwe. DESIGN: Prospective study. SETTING: Sekuru Kaguvi Eye Unit. SUBJECTS: All patients who presented with conjunctival growths in July 2004. MAIN OUTCOME MEASURE: Relative risk. RESULTS: The relative risk of being HIV positive among patients with ocular surface squamous neoplasia was 3.6 with 95% CI 1.5 to 8.6. The mean CD4 cell count level was significantly lower among OSSN patients when compared to patients with non-ocular surface squamous neoplasia. RECOMMENDATIONS: 1. HIV related malignancies can be used as an indicator of when to commence patients on anti-retroviral (ARVs) when CD4 counts are not accessible; 2. Medical practitioners in resource-poor settings should conduct meaningful operational research as part and parcel of their routine clinical work using available resources, since funding is not readily available.

Vitamin A status of term and preterm infants delivered at Harare Central Hospital and fed exclusively on breast milk.

OBJECTIVE: To investigate the vitamin A status of pregnant mothers, lactating mothers, preterm and term infants who were being fed exclusively on breast milk. DESIGN: Systematic/cross sectional. SETTING: Vitamin A research laboratory, animal science research laboratory, University of Zimbabwe, and Harare Central Hospital. SUBJECTS: 105 pregnant mothers attending the antenatal clinic at Harare Central Hospital for a routine check up were recruited for the study. Two groups of infants: those born at term and those with gestational age < or = 36 weeks. MAIN OUTCOME MEASURES: Serum retinol levels of infants/mothers pairs. Breast milk retinol levels. RESULT: The serum retinol levels for the infants were similar irrespective of age with a mean of 26.15 +/- 9.78 microg/dl. There was no statistically significant difference. The mean serum retinol levels of infants and mothers were significantly different, (p = 0.001). With mother/infant ratio of serum retinol concentration of 1.7:1. Maternal serum retinol levels correlated positively with infant serum retinol levels, r = 0.728. Forty four percent of the preterm and 17% of the term infants had serum retinol levels < 20 microg/dl, indicating deficiency, 2 and only 20% of the infants had retinol levels > 40 microg/dl. CONCLUSION: The majority of infants might be at risk of vitamin A deficiency. Increased intake of vitamin A in pregnant women is necessary, and direct vitamin A supplementation of infants should be considered.

HIV infection reduces skin graft survival in burn injuries: a prospective study.

UNLABELLED: Impaired survival of skin grafts has been noted in human immunodeficiency virus (HIV) infected patients, but the reason is not known. Alterations in inflammatory response, which might be recorded as an imbalance in cytokine production, have been implicated. The aim of this study was to determine the impact of HIV infection in patients with burn injuries by comparison of split skin graft survival, T lymphocyte count and cytokine levels in HIV-infected and non HIV-infected patients in relation to healthy and HIV-infected nonburnt volunteers.Fifty-four patients with deep dermal burns were included. Fifteen patients' were HIV-infected. Thirteen healthy and 15 HIV-infected, volunteers were recruited as controls. The burnt surface area was traced on a transparent plastic sheet and converted to area. Graft survival on day of discharge/regraft for non HIV-infected patients was 69%, and in HIV-infected 22%, (p<0.05). The median length of hospital stay for early excision among non HIV-infected patients was 21 (12-53) days and for HIV-infected, 41 days (p<0.05). Serum protein levels in HIV-infected patients were elevated compared to non HIV-infected patients (p<0.05). CD4+ lymphocytes were depressed in HIV-infected volunteers and HIV-infected burn patients compared to healthy volunteers (p<0.05). CD8+ lymphocytes were elevated in HIV-infected volunteers compared to non HIV-infected burn patients. Pro-inflammatory cytokine levels of Interleukin-2 (IL-2), Interleukin-6 (IL-6), Interferon-gama (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were depressed in HIV-infected volunteers compared to healthy volunteers and non HIV-infected burn patients. The pro-inflammatory cytokine IFN-gamma did not increase after burn injury in HIV-infected burns patients as did IL-2, IL-6 and TNF-alpha (p<0.05). Anti-inflammatory cytokine levels of IL-4 were elevated in HIV-infected volunteers compared to healthy volunteers and burn patients (p<0.05). CONCLUSION: Graft survival after split skin grafting of burn wounds in HIV-infected patients is impaired and hospital stay is prolonged. HIV infection result in immune dysregulation, which might be related to impaired skin graft survival.

Polymorphism at the -308-promoter position of the tumor necrosis factor-alpha (TNF-alpha) gene and cervical cancer.

The purpose of the study was to investigate the hypothesis that the genetically programmed ability to produce low, medium, or high levels of tumor necrosis factor-alpha (TNF-alpha), as determined by TNF-alpha promoter polymorphism at position 308, influenced the development of cancer of the uterine cervix. The population was recruited from patients attending gynecological clinics at two teaching hospitals in Harare, Zimbabwe. Laboratory tests were performed in the Departments of Immunology and Medical Microbiology, Medical School, University of Zimbabwe. One hundred and three patients with invasive cancer of the uterine cervix and 101 healthy women were included in the study. All patients and healthy controls were from the Shona ethnic groups that inhabit northern Zimbabwe. DNA was purified from cervical cytobrush samples obtained from women with cervical cancer. In random cases a second DNA sample was extracted from patient blood. Control DNA was extracted from urine or peripheral blood samples from the healthy women. Detection of allele A and /or G at the 308 position in the promoter region of the TNF-alpha gene was carried out using the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) technique. Polymorphism in the amplified products was detected by gel electrophoresis. There was no statistically significant difference in the distribution of the low (G) or high (A) producer alleles at position 308 of the TNF-alpha gene between patients with cervical cancer and healthy women. The high producer haplotype AA was identified in only one patient with cervical cancer and two healthy women. These data suggest that the genetically acquired ability to produce higher levels of TNF-alpha is present in a minority of women with or without cervical cancer in the Zimbabwean population. Homozygosity for allele 308A is very rare. High-producer allele 308A as well as high-producer haplotypes AA is significantly less common in a Zimbabwean population than in a European population.

Analysis of the sensitization profile towards allergens in central Africa.

BACKGROUND: Almost no information is available regarding the prevalence of IgE-mediated allergies and the disease-eliciting allergens in tropical Africa. OBJECTIVE: To study IgE-mediated allergies and the allergen profile in allergic patients from Zimbabwe. METHODS: The frequency of sensitization to common environmental allergen sources was determined by skin prick testing in 650 allergic patients from Zimbabwe. Fifty representative sera were analysed for IgE reactivity to 20 respiratory and 20 food allergen extracts by multiallergen extract testing. The IgE reactivity profiles to recombinant pollen and mite allergens were compared between grass pollen- and mite-sensitized patients from Zimbabwe and central Europe. Sera from grass pollen-allergic patients were also analysed for IgE reactivity to nitrocellulose-blotted natural timothy grass and Bermuda grass pollen allergens. RESULTS: IgE-mediated allergies were found to be common in Zimbabwe. Similar to the situation in central Europe, mites and grass pollens represented the most prevalent allergen sources. However, the IgE reactivity profiles determined with single recombinant pollen and mite allergens revealed interesting differences between the European and African patients, which most likely reflect the local allergen exposure. CONCLUSIONS: The striking differences regarding sensitization to grass pollen and mite allergens between African and European patients revealed by recombinant allergen-based testing emphasize the need for component-resolved allergy testing to optimize allergy prevention and therapy in different populations.

Polymorphism in codons 10 and 25 of the transforming growth factor-beta 1 (TGF-beta1) gene in patients with invasive squamous cell carcinoma of the uterine cervix.

Transforming growth factor-beta 1 (TGF-beta1) has a multifactorial role in the development of cervical cancer. It potently inhibits the growth of epithelial cells that harbour oncogenic human papilloma viruses (HPVs). TGF-beta1 also inhibits the expression of the early viral transforming regions E6 and E7, which appear to be the key oncoproteins. It has been suggested that squamous cell carcinomas are devoid of TGF-beta1, raising the possibility that elevated levels of this growth factor could protect against cervical cancer. It is also recognized that the production and levels of TGF-beta1 are genetically predetermined and individually variable. Two genetic polymorphisms in the DNA encoding the leader sequence of the TGF-beta1 gene have been described and shown to be associated with the production of high or low TGF-beta1 levels in vivo and in vitro. We hypothesized that the inheritance of these polymorphisms could influence the development of invasive cervical cancer. This hypothesis was investigated by studying polymorphism in codons 10 and 25 of the TGF-beta1 gene. We studied 97 patients with invasive cervical cancer and 73 healthy controls and found that the distributions of alleles T (Leu) and/or C (Pro) and alleles G (Arg) and/or C (Pro) in codons 10 and 25, respectively, were similar. There was no significant association between the alleles and the histological degree of cancer differentiation. It appears that the role of this growth factor in cervical oncogenesis is not related to the point mutations that we examined in codons 10 and 25 of the TGF-beta1 gene. We speculate that other factors, including additional polymorphisms of the TGF-beta1 gene, the status of TGF-beta1 receptors, the complex cytokine network, differential responsiveness of cells to the stimuli, and the status of the precancer/cancer genome, may play a role in development of invasive cervical cancer.

Awareness of the risks of HIV infection by Zimbabwean urban and rural high school attendees.

OBJECTIVES: The purpose of this report was to investigate the awareness by high school attendees of risky behaviour likely to lead to sexually transmitted infections (STIs) including HIV/AIDS and to assess their preparedness to prevent or obviate the consequences. DESIGN: Cross sectional study. SETTINGS: A small town located 100 km south of the Zimbabwean capital, Harare and in communal and commercial farming areas within a 50 km radius of the town. METHODS: With the permission of school authorities, a group of second year medical students from the University of Zimbabwe on rural attachment administered an anonymous questionnaire to teenagers attending four high schools in the study area. Specific questions to determine whether the teenagers were sexually active and if they used any protection during sex were incorporated into a general and environmental health questionnaire. RESULTS: A total of 241 teenagers, 153 boys and 89 girls from all four schools completed the questionnaire. The percentages of sexually active boys (48%) and girls (49%) were similar. The majority had heterosexual preferences, 4.6% boys were homosexual. Half (50%) of the 16 year old pupils were sexually active. There were more urban than rural school attendees who reported personal knowledge of someone with HIV or AIDS. Condom use was low. CONCLUSION: We found that half of the 16 to 19 year old students were sexually active. Rural school attendees were more likely to be sexually active and less likely to practice safe sex. We conclude that the risk of sexually transmitted diseases (including HIV) amongst these teenagers is significant and recommend that, there is a need to design a group targeted awareness programme in order to obviate sexually transmitted diseases including HIV.

Determination of normal ranges for serum C3 and C4 levels in an adult Zimbabwean population.

OBJECTIVE: To determine reference levels of serum complement proteins (C3 and C4) by analyzing the concentrations of this serum component in blood samples drawn from otherwise healthy adult Zimbabweans. DESIGN AND SETTING: This was a cross sectional study carried out at the University of Zimbabwe College of Medicine and National Blood Transfusion Services, Harare, Zimbabwe. SUBJECTS: Ninety five ethnically heterogenous apparently healthy blood donors aged between 18 and 60 years were enrolled in the study. These included 50 males and 45 females. MAIN OUTCOME MEASURES: Serum C3 and C4 levels were determined using an immuno-turbidimetric method. RESULTS: Serum levels of complement (C3) ranged from 66 to 185 mg/dl. The respective levels of C4 were 15 to 52 mg/dl. These values varied significantly with age. Serum levels of C3 in patients aged 18 to 50 years were 63 to 192 mg/dl; they were lower (80 to 124 mg/dl) in patients in the 51 to 60 year old age bracket. C4 levels were lower (12 to 49 mg/dl) in the younger adults (18 to 40 years) than in those aged 41 to 60 years (24 to 53 mg/dl). The levels of both C3 and C4 did not vary with gender. CONCLUSION: This study is probably the first to establish local reference ranges for C3 and C4 in Zimbabwe. These results should find useful clinical and research application.

Acetyl salicylic acid (aspirin), micronutrients and chloroquine in the management of the acquired immunodeficiency syndrome (AIDS).

OBJECTIVES: We have previously investigated the role of either: aspirin and micronutrients or aspirin, micronutrients and chloroquine (CQ) in the management of asymptomatic HIV infected individuals. In this paper, we report the use of these combinations in the management of patients with AIDS, defined as CD4 count < 200 cells.

Cancer of the uterine cervix may be significantly associated with a gene polymorphism coding for increased IL-10 production.

The purpose of our prospective, case-controlled study was to investigate the hypothesis that women who are genetically programmed to produce high or medium levels of IL-10 were more likely to develop cancer of the uterine cervix than individuals genetically predisposed to low IL-10 production. The population was recruited from patients attending gynecological clinics at 2 hospitals in Harare, Zimbabwe. Laboratory tests were performed in the Departments of Immunology, Chemical Pathology and Medical Microbiology, Medical School, University of Zimbabwe, and simultaneously at the Department of Biological Sciences, University of Manchester, United Kingdom. Included in our study were 77 women with histologically proven cancer of the uterine cervix and 69 age- and parity-matched healthy women. All of the patients and healthy controls were from the Shona ethnic group that inhabits northern Zimbabwe. DNA was purified from cervical cytobrush samples obtained from women with cervical cancer. Control DNA was extracted from urine or peripheral blood samples from the healthy women. The Qiagen DNA extraction kit was used. Detection of allele A and/or G at -1082 in the promoter region of the IL-10 gene was carried out using the ARMS-PCR technique. Polymorphism in the amplified products was detected by gel electrophoresis in the presence of ethidium bromide and were bands visualized under UV light. The data comprise 77 women who developed invasive cervical cancer and 69 healthy women matched for age and parity. Patients with cancer were significantly (p = 0.001) more likely to be predisposed to produce higher (A/G) levels of IL-10. The genotype encoding for high (G/G) production of IL-10 was only observed in one cancer patient. The prevalence of low producers of IL-10 in the cancer group was significantly lower than in the healthy women. There were no high producers amongst the healthy women. These data suggest that the genetically acquired ability to produce higher levels of IL-10 may be a significant factor in the development of cervical cancer.

Research and clinical aspects of immunology in Africa.

There are few immunologists in Africa. Researchers predominantly study the immunology of infectious diseases (HIV, malaria and tuberculosis), HLA genotypes and cytokine secretion patterns. Lack of research funding is the problem; continued, equitable international collaboration is a short-term answer. Sustainable development will come when African countries find ways of training and retaining scientists who will produce research and diagnostic tests. The Internet should be utilized to improve communication and as a conduit for online, virtual immunology courses.

Antiretrovial (ARV) drug utilisation in Harare.

OBJECTIVE: To investigate ARV utilisation in Harare in order to gather necessary data to help in the formulation of treatment guidelines to be used in Zimbabwe. DESIGN: A cross sectional study. SETTING: Doctors' rooms and retail pharmacy outlets. SUBJECTS: 68 primary care physicians, 80 pharmacists and 92 patients. MAIN OUTCOME MEASURES: Number of physicians prescribing antiretroviral agents (ARVs) and pharmacists stocking ARVs. Type of ARV utilised, cost to the patient and information on ARV available. RESULTS: Out of the 68 private practitioners interviewed 18 were prescribing ARVs during the period of study. There were 92 patients on ARVs whose mean age was 35 +/- 5 years and consuming an average total of 17 tablets daily. Thirteen out of the 18 doctors had access to laboratory facilities to determine CD4 counts and viral load. The rest were using other approaches to treat and manage HIV/AIDS patients. About a quarter, 27.0%, of the retail pharmacists stocked ARVs. The majority, 82.0%, of the patients appeared to be on Zidovudine (AZT) mainly in combination with other drugs. The most popular combination was that of AZT, Lamivudine (3TC) and Indinavir prescribed to 29.0% of the patients, followed by that of Didanosine (DDI) and hydroxyurea prescribed to 17% of patients. At least 17% of the patients were on AZT monotherapy. There was no significant difference (p = 0.06) in the number of tablets consumed by patients who had other conditions secondary to HIV infection. Only 39 out of the 92 patients reported untoward experiences with ARVs. The major problem being associated gastro-intestinal disturbance which accounted for 56% of the reports. It was not possible to ascertain adherence. CONCLUSION: There appeared to be therapeutic anarchy in the private sector in Harare in the way ARVs were being used. Patients need to be told that deciding to take one of the combinations means making a serious commitment to the drugs on schedule if they want to enjoy the benefit. At the same time there is need to develop and publicize HIV/AIDS treatment guidelines and effective Information, Education and Communication (IEC) materials specific to Zimbabwe.

Plasma HIV-1 RNA quantitation in HIV infected adult Zimbabweans.

OBJECTIVES: To determine HIV-1 RNA levels in plasma of HIV infected Zimbabwean adults and to correlate these with CD4+ cell counts. DESIGN: Prospective observational study. SETTING: Specialist Immunology Laboratory, Harare, Zimbabwe. SUBJECTS: 49 consecutive HIV infected patients. MAIN OUTCOME MEASURES: CD4+ cell counts and plasma HIV-1 RNA levels. RESULTS: Based on the CDC HIV classification system five patients were in early stage infection, 15 in middle, 17 in late and 12 in advanced stage of infection. The median CD4+ cell count was 165/microL (Q1 = 4; Q3 = 866). The median HIV-1 RNA levels were 73,097 RNA copies/ml (Q1 = 753; Q3 = 750,000). Eighty percent of the patients had HIV-1 RNA levels > 10,000 copies/ml and 49% had > 100,000 RNA copies/ml. Median viral loads among the four categories of infection were found to be highly significant (p < 0.001). The correlation between CD4+ cell counts and HIV-1 RNA copies for the 49 patients was highly significant (r = -0.76; p < 0.001). CONCLUSIONS: High treatment HIV-1 RNA levels were determined in the majority of patients. A highly significant correlation was obtained between plasma HIV-1 RNA levels and CD4+ cell counts.

Aero-allergen sensitisation patterns amongst atopic Zimbabwean children.

OBJECTIVE: To characterize children presenting with atopic conditions using the RAST test. DESIGN: Retrospective descriptive study. SETTING: General paediatric clinic in the private sector. SUBJECTS: 84 children aged below 12 years, who had the RAST test, who presented to a general paediatric clinic between 1993 and 1998 with atopic conditions for care. RESULTS: The median age for all children in the study was 52 months. Forty eight were male and 36 female. Eczema (33.9%) was the most frequent clinical diagnosis especially in those less than 24 months of age, followed by asthma (25.5%), allergic conjunctivitis (24.0%) and allergic rhinitis (15.6%). Total IgE was not statistically significantly associated with clinical diagnosis(p = 0.889), age of the child (p = 0.102), gender (p = 0.687) or absolute eosinophil count (p = 0.318). The commonest allergens identified were dust mite (Dermatophygoides pteronissinus and D. farinae) and Bermuda grass. While antibody reaction to weeds, particularly plantain, were also common, these reactions were mostly mild to moderate. Allergy to cats and moulds was rare. CONCLUSION: In the absence of routine testing for specific allergens avoidance of dust mite and Bermuda grass seem important strategies in the management of difficult children with atopy. There is need for a prospective study to shed more light on the allergens that cause these common atopic conditions in our environment.

SLE and HIV infection, two systemic conditions that can be clinically indistinguishable.

Systemic lupus erythematosus (SLE), the prototypic auto-immune disease, commonly affects Black patients. This connective tissue disease may involve the lymphoid organs, kidneys, skin, lungs and the central nervous system. The same organs are involved in HIV disease. We report on a patient who fulfilled both the American Rheumatism Association (ARA) (1982) criteria for the diagnosis of SLE and WHO (Bangui) clinical criteria for the diagnosis of AIDS in Africa. The patient had no laboratory evidence of HIV infection. The pitfalls associated with reliance on cheap guidelines are discussed in the context of the resources required for the effective differentiation of the disparate systemic conditions.

Lymph node pathology in Zimbabwe: a review of 2194 specimens.

When the body's defences are breached by infection, information about such an event is channelled through the lymphatic system to the lymphoid organs in which immune responses occur. The key participants in these responses are lymphocytes, which populate the lymph nodes, spleen, and mucosal lymphoid tissues. Together with other cells, they form an architecture and cell network that enables coordinated function. The lymph nodes, which are usually superficial, are easily accessible and therefore frequently sampled by clinicians. The findings on such samples are invaluable in the diagnosis, staging, treatment and prognosis of disease. From the 28,895 histology specimens submitted to the Histopathology unit in Harare, Zimbabwe in the period January 1988 to June 1990, we have selected and reviewed all lymph node biopsy reports. The commonest diseases in the 2194 lymph node specimens submitted were: (a) non specific hyperplasia (33%); (b) tuberculous lymphadenitis (26.7%); (c) metastases (12.4%); (d) Kaposi's sarcoma (9%); (e) lymphomas (7%). The trends for nodal tuberculosis (including hyporeactive tuberculous lymphadenitis), Kaposi's sarcoma, florid follicular hyperplasia and lymphomas are discussed in the context of the increased incidence of HIV-related lymphoadenopathy.