Discordant rapid HIV tests: lessons from a low-resource community.

OBJECTIVES: HIV rapid antibody tests are widely used in Africa, but dual testing sometimes produces discordant results. It is not clear if discordant rapid HIV tests should always heighten suspicion by frontline health workers that early HIV infection is present. Some studies have reported that discordant rapid tests have value for identifying early HIV infection in high HIV prevalence populations. It is not known if rapid test performance influenced this conclusion, or if this observation will hold true for low HIV prevalence populations. We therefore explored the occurrence of discordant rapid HIV tests in a low-resource community. METHODS: A cross-sectional sample of HIV status-unaware adults with recent exposure to unsafe sex was assessed using a validated risk-based tool (University of North Carolina (UNC)-Malawi Risk Screening Score) for acute HIV infection. Participants received rapid testing with Determine™ HIV 1/2 and Uni-Gold™ HIV assays, plus plasma HIV-1 antigen testing with the COBAS® Ampliprep/COBAS® Taqman® HIV-1 assay, followed by western blot in those with detected HIV-1 antigen. RESULTS: Of 408 participants, 1.0% were confirmed to have established HIV infection. The discordance between rapid tests at initial screening was 2.45 and 2.94% when the two assays were used sequentially and simultaneously, respectively. Discordant rapid tests were strongly associated with risk scores > 2 [odds ratio (OR) 10.88; 95% confidence interval (CI) 2.35-50.43], and with detected HIV-1 RNA (OR 26.06; 95% CI 3.91-173.60). CONCLUSIONS: When the sample occurrence of discordance between the first and second tests is below 5%, discordant rapid tests in an adult with sexual risk behaviour should trigger strong suspicion of early HIV infection in low HIV prevalence populations.

Is there any relationship between hearing threshold levels and CD4 cell count of human immunodeficiency virus infected adults?

Background The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults. METHODS: This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly -active antiretroviral therapy (HAART) were obtained. Audiornetric evaluation was performed. The most recent CD4 cell counts and RNA viral load-of HIV-infected participants were obtained from clinic records. RESULTS: There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.64± 12.45 years and 39.60±12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV- infected participants and 53.7% controls. Majority (86.3%) of the HIV-infected participants were on HAART. The mean CD4 cell count was 654.58±289.15 in 41 HIV-infected participants not on HAART and 523.95±300.17 in 258 participants on HAART (p=0.01). Majority,- 197 (62%) HIV- infected participants with hearing loss had CD4 cell count ≤200 cells/mm3. Higher viral load significantly correlated with low CD4 cell counts (p<0.0 1; r=0. 18) and low CD4 cell count significantly correlated with high hearing threshold (p

Temporal changes in renal glomerular function associated with the use of Tenofovir Disoproxil Fumarate in HIV-infected Nigerians.

BACKGROUND: Reports of renal dysfunction in Tenofovir Disoproxil Fumarate (TDF)-treated HIV-1 infected patients have raised concerns about potential nephrotoxicity. OBJECTIVE: To compare the effects on renal function of TDF-containing highly active anti-retroviral therapy (HAART) with a non-TDF-containing HAART. METHODS: This was an observational study.Clinical and laboratory data of 186 HIV-1 infected adult Nigerians on first-line HAART for at least 48 weeks were reviewed. Eighty-four patients whose nucleos(t)ide reverse transcriptase inhibitor (NRTI) backbone included TDF were compared to 102 patients on other NRTI backbones. Creatinine clearance (CLcr) was estimated using the Cockcroft-Gault equation. Changes in serum creatinine and CLcr from the baseline for each patient were compared between the TDF-treated and the TDF-free patients. We also assessed the associations of other variables with change in CLcr... RESULTS: Baseline median serum creatinine (mmol/L) was 77 and 84 in the TDF-treated and TDF-free groups, respectively (p=0.59). Baseline median CLcr (mls/min) was 83 in the TDF-treated patients vs 78 in the TDF-free group. At 48 weeks, serum creatinine increased by 18.1% and 1.2% in the TDF-treated and TDF-free arms, respectively. There was a decrease of 4.8% in GFR in the TDF arm compared to a gain 5.1% in the TDF-free arm. CONCLUSION: Tenofovir Disoproxil Fumarate-containing HAART is associated with a slight decline in the medium term in CLcr compared with HAART regimens containing alternative Nucleosid(t) Reverse Transcriptase Inhibitors.

Higher risk of AIDS or death in patients with lower CD4 cell counts after virally suppressive HAART.

BACKGROUND: The clinical implications of a failure to achieve high CD4 cell counts while receiving virally suppressive highly active antiretroviral therapy (HAART) are uncertain. METHODS: We analysed data from HIV-infected men participating in the Multicenter AIDS Cohort Study (MACS) to elucidate associations between CD4 cell counts achieved during virally suppressive HAART and risks of AIDS or death. Inclusion criteria were: CD4 cell count <200 cells/microL before HAART initiation; >or=2 viral load (VL) determinations after HAART initiation; and sustained viral suppression, defined as all VL <50 HIV-1 RNA copies/mL, but allowing a single VL of 50-1000 copies/mL. RESULTS: One hundred and twenty-one men were included; median age was 42 years. After first VL <50 copies/mL, six participants had a new AIDS diagnosis and seven died. The median CD4 cell count change/year (cells/microL) after first VL <50 copies/mL was zero among patients who either developed AIDS or died vs. 39 among those who did not meet either endpoint (P=0.119). After controlling for time from HAART initiation to first VL <50 copies/mL, age at first VL <50 copies/mL, history of AIDS and antiretroviral therapy (ART) experience before HAART, the hazard ratio for AIDS or death at CD4 cell count of 350 cells/microL was 10.7 (P=0.013), and at CD4 cell count of 201-350 vs. >350 cells/microL was 8.54 (P=0.014). CONCLUSION: In this cohort, lower CD4 cell count at the time of viral suppression was associated with increased risk of AIDS or death.

Knowledge of Prostate Cancer and Screening Among Young Multiethnic Black Men.

The purpose of this study was to assess the knowledge of prostate cancer and screening and its associated factors in young Black men aged 18 to 40 years. This was a cross-sectional study conducted in a convenience sample of 267 young Black men in Austin, Texas. Knowledge about prostate cancer and screening was operationalized through 14 items, including 12 items from the Knowledge about Prostate Cancer Screening Questionnaire (PC knowledge), and two items assessing dietary knowledge and prostate cancer screening controversy. PC knowledge scores were regressed on age, cues to action, health screening experience, and demographic/personal factors. Most participants were African American men of American origin (65.3%) and were college freshmen (18.9%). PC knowledge scores were low, with mean correct responses of 28.5%, mean knowledge score of 5.25 ± 3.81 (possible score range of 0 to 14, with higher scores indicating higher PC knowledge) and a median score of 5.00. On average, 47% of the respondents replied "Don't Know" to the questions. Overall, PC knowledge scores were low among these young Black men, especially in domains related to risk factors, screening age guidelines, limitations, and diet. It is thus important that these men be educated more on these important domains of prostate cancer and screening so that the decision to screen or not will be an informed one. Health screening experience, residence area, major field of study, and academic classification were significant predictors of knowledge.

Beliefs Regarding Prostate Cancer Screening Among Black Males Aged 18 to 40 Years.

This study was conducted to identify the salient behavioral beliefs of young Black men toward prostate cancer screening, and to identify the issues surrounding their comfortability with prostate examinations. A total of 20 Black men, aged between 18 and 40 years, participated in three focus group sessions between June 2013 and July 2013 in Austin, Texas. Participants were asked open-ended questions about: (a) the advantages and disadvantages of screening to identify salient behavioral beliefs about screening and (b) issues that would make prostate examinations comfortable or uncomfortable to identify comfortability factors. Focus group discussions were tape-recorded, transcribed, and content analyzed to identify emerging themes of salient beliefs and comfortability. Also, nine salient behavioral beliefs toward prostate cancer screening were identified, and eight factors were linked to comfortability with prostate examinations. Given the increase of prostate cancer disparity as a public health issue, understanding the beliefs of Black men of prescreening age (18-40 years) may be crucial to the effectiveness of future interventions to improve screening when recommended at later ages.

Nevirapine toxicity.

The number of HIV-infected patients who are newly exposed to nevirapine is increasing worldwide. To minimize toxicity, clinicians must adhere to dosing guidelines, avoid prescribing the drug in patients with known increased risk of toxicity, and promptly recognize toxicities, which are mainly cutaneous and hepatic. These toxicities are more common with nevirapine than with efavirenz. Women with CD4 counts>250 cells/mm3 have particularly increased susceptibility to nevirapine toxicity. Improved understanding of the pathogenesis of nevirapine toxicity, and its relationship with pharmacokinetic parameters, genetic factors and cellular immune kinetics will enhance our ability to reduce the risk to the HIV-infected individual.

Antiretroviral treatment: current approach and future prospects.

Pharmacologic treatment of HIV infection involves the combination of drugs that exert their antiretroviral effects at different stages in the life-cycle of the virus. Strongpublic-health programs are necessary for HIV control. To be successful in treating HIV, the clinician must establish a treatment alliance with the patient to forge optimal adherence to the treatment regimen. Potential adverse reactions,toxicities and drug-drug interactions must be understood and detected early. Disparity exists in the treatment of HIV between most African and western countries and can be bridged through improved access to drugs and treatment infrastructure. The search for a cure is led by ongoing research in novel concepts such as structured treatment intervention and immune-based therapy.

HIV-associated wasting: brief review and discussion of the impact of oxandrolone.

This is a brief review of human immunodeficiency virus (HIV)-associated wasting with expanded discussion of one treatment agent, oxandrolone. HIV-associated wasting is the involuntary loss of more than 10% of baseline body weight in the presence of chronic diarrhea, weakness, or fever lasting longer than 30 days. For patients, this clinical syndrome has special importance because it affects not only their survival but also their physical appearance and social interactions. Pharmacologic treatment is only one of the many approaches that need to be explored in every patient who presents with this condition. In 1964, oxandrolone became the first drug approved for the treatment of wasting. Since then its role has expanded to HIV-associated wasting. As an anabolic agent oxandrolone reverses many of the metabolic abnormalities characteristic of HIV-associated wasting leading to dose dependent increase in nitrogen retention. Similar to many other HIV treatments, gaps exist in our knowledge of the role of oxandrolone in HIV-associated wasting. These gaps will be filled only by years of field exposure and further clinical research.

AIDS-related primary CNS lymphoma: a brief review.

Primary CNS lymphoma, which has a strong association with Epstein-Barr virus, was increasing in incidence in patients with AIDS before the introduction and widespread use of combination antiretroviral therapy. The diagnostic strategies for primary CNS lymphoma, including contrast-enhanced CT or MRI and brain biopsy, are well established. The use of a combination of diagnostic tools to reduce the need for brain biopsy is currently being evaluated. The clinical outcome with current treatments for primary CNS lymphoma in HIV-infected persons remains relatively discouraging.

Use of thalidomide in HIV infection.

Despite its disastrous past, thalidomide has reentered the medical community. This article reviews available evidence for its potential application to the treatment of some complications of HIV infection. HIV-related conditions in which thalidomide may be useful include aphthous ulcers, wasting, diarrhea, and nodular prurigo. Vigilance must be maintained to minimize adverse effects and prevent fetal exposure.

Testicular microlithiasis and epididymo-orchitis: aetiological factor or coincidence?

Testicular microlithiasis, also referred to as intratubular testicular calcification, is an uncommon urological curiosity of unknown aetiology. A case of epididymo-orchitis occurring in microlithiasis is reported and their possible association is discussed.

Antimicrobial and antiplasmodial activities of a quaternary compound from Ritchiea capparoides var. longipedicellata.

UNLABELLED: The leaves of Ritchiea capparoides var. longipedicellata (Capparidaceae) is used in ethnomedicine in South-Western Nigeria to treat infectious and parasitic diseases. This study was aimed at identifying the compound(s) that are responsible for the antimicrobial and antiplasmodial activities of the leaves and also to contribute to the chemistry of the plant species. A 70 % aqueous ethanolic extract of the leaves of R. longipedicellata was subjected to repeated liquid chromatographic methods on silica gel, Lobar RP-18 column and Sephadex LH-20 to isolate a Draggendorf positive compound. The compound was identified by (1)H and (13)C NMR, ultra-violet spectroscopy and polarimetry. The antimicrobial activity of the compound was evaluated using the microbroth dilution method while the antiplasmodial activity was carried out according to Trager and Jenson (1976). The minimum inhibitory concentration (MIC) was expressed in mg/ml. The isolated compound, leavoisomer of stachydrine, inhibited the growth of Escherichia coli NCTC 8196 and Staphylococcus aureus NCTC 6571 at the MIC of 5 mg/ml. In the anti-malaria assay, the compound had inhibitory activity with the concentration required to cause 100% lethality being 0.667 mg/ml. CONCLUSION: The antibacterial and antiparasitic effects of quaternary ammonium compounds are well documented. However, this study is the first report of the presence and biological activities of this compound in this plant species which may justify the ethnomedicinal uses of the leaves.

Mycobacterium tuberculosis and Mycobacterium africanum in stools from children attending an immunization clinic in Ibadan, Nigeria.

BACKGROUND: Tuberculosis is a major cause of childhood morbidity and mortality in Nigeria. Diagnosis of childhood tuberculosis is a global challenge making early treatment a mirage. In this study we investigated the stools of children for the presence of mycobacteria. METHODS: Stool samples from children aged 3 days to 3 years who presented for postnatal immunization at a large university-based clinic in Nigeria, were subjected to Ziehl-Neelsen staining. Samples with acid-fast bacilli were further processed using mycobacterial culture, spoligotyping, and deletion typing. RESULTS: One hundred and ninety-two stool samples from different children were collected and processed. Thirty (15.6%) had acid-fast bacilli. Of these, eight had Mycobacterium tuberculosis and one had Mycobacterium africanum. CONCLUSIONS: Approximately 5% (9/192) of apparently well children had evidence of potentially serious tuberculosis infection. The usefulness of stool specimens for diagnosing pediatric tuberculosis warrants further investigation.

Antimicrobial and antioxidant activities of some Nigerian medicinal plants.

Ten Nigerian plants suggested from their ethnomedical uses to possess antimicrobial and antioxidant activities were studied for their anti-microbial and anti-oxidant properties. Antimicrobial activity was tested against Escherichia coli NCTC 10418, Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis, Candida albicans, Candida pseudotropicalis and Trichophyton rubrum (clinical isolate). Trichilia heudelotti leaf extract showed both antibacterial and antifungal activities and was the most active against all the strains of bacteria tested. Boerhavia diffusa, Markhamia tomentosa and T. heudelotti leaf extracts inhibited the gram negative bacteria E. coli and P. aeruginosa strains whereas those of M. tomentosa, T. heudelotti and Sphenoceutrum jollyamum root inhibited at least one of the fungi tested. At a concentration of 312 microg/ml, hexane and chloroform fractions of T. heudelotti extract inhibited 6 and 14% of the fifty multi-drug resistant bacteria isolates from clinical infections, respectively. At < or = 5 mg/ml, the CHCl(3) (64%) and aqueous (22%) fractions of T. heudelotti and those of CHCl(3) (34%) and EtOAC (48%) of M. tomentosa gave the highest inhibition that was stronger than their corresponding methanol extracts. The corresponding EC(50) of the extracts on M. acuminata, T. heudelotti, E. senegalensis and M. tomentosa were 4.00, 6.50, 13.33, and 16.50 ig/ml using the TLC staining and 1,1-dipheyl-2-picry-hydrazyl (DPPH) free radical scavenging assay. Therefore, leaf extracts of M. tomentosa and T. heudelotti, especially the latter, possess strong antimicrobial and antioxidant activities and should be further investigated. These activities justified the ethnomedical uses of these plants.

Psoas abscess: a primer for the internist.

Psoas abscess is a rare condition with vague clinical presentation. In this article, its epidemiology, etiology, bacteriology, diagnosis, and treatment are discussed. Common diseases that may be erroneously diagnosed in patients with psoas abscess are presented.

Cardiac arrest: a rare complication of pallid syncope?

Cardiac arrest is rare in children. Breath-holding, on the other hand, is fairly common. We report a case in which one complicated the other with serious consequences. A review of the literature on the subject was undertaken.

Crossbreeding in tropical sheep: incidence of dystocia and parturition losses.

Studies were carried out on the incidence of dystocia and parturition losses during a crossbreeding experiment involving 96 West African Dwarf (WAD) ewes mated with rams of 4 breeds--WAD, Ouda, Permer and Yankassa. Results obtained indicated 8 (5.7%) cases of dystocia and 20 (10.64%) cases of stillbirths or death of lambs at birth. The WAD sires were not associated with dystocia or stillbirths but other sire groups were involved in both. All the difficult parturitions occurred during the rainy season while all stillbirths not associated with dystocia occurred during the dry season. The sires used and the level of feeding the ewes during pregnancy may be associated with the dystocia cases and parturition losses recorded. Eighty per cent of the dystocias involved ram lambs. The mean gestation period of the ewes that lambed during the dry season was significantly (P < 0.01) longer than that of the rainy season group. Application of traction and Caesarean operation were used in the treatment of dystocia cases.