Changing landscape of acute encephalitis syndrome in India: A systematic review.

Background. Seasonal outbreaks of acute encephalitis syndrome (AES) occur with striking regularity in India and lead to substantial mortality. Several viruses, endemic in many parts of India, account for AES. Although Japanese encephalitis virus (JEV) is a key aetiological agent for AES in India, and has attracted countrywide attention, many recent studies suggest that enteroviruses and rhabdoviruses might account for outbreaks of AES. We did a systematic review of published studies to understand the changing landscape of AES in India. Methods. Data sources: Electronic databases (PubMed, Web of Science and BIOSIS) from the start of the database to 2010. We also hand-searched journals and screened reference lists of original articles, reviews and book chapters to identify additional studies. Study selection: We included studies only on humans and from three time-periods: pre-1975, 1975–1999 and 2000– 2010. Data extraction: Independent, duplicate data extraction and quality assessment were conducted. Data extracted included study characteristics, type of study and aetiological agent identified. Data synthesis: Of the 749 unique published articles screened, 57 studies met the inclusion criteria (35 outbreak investigations and 22 surveillance studies). Results. While most studies from 1975 to 1999 identified JEV as the main cause of AES, many studies published after 2000 identified Chandipura and enteroviruses as the most common agents, in both outbreaks and surveillance studies. Overall, a positive yield with respect to identification of aetiological agents was higher in outbreak investigations as compared to surveillance studies. Conclusion. The landscape of AES in India has changed in the previous decade, and both outbreak investigations and surveillance studies have increasingly reported non-JEV aetiologies. Because of these findings, there is a need to explore additional strategies to prevent AES beyond vector control and JEV vaccination.

Prevalence & correlates of primary infertility among young women in Mysore, India.

Background & objectives: There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India. Methods: The baseline data were collected between November 2005 through March 2006, among 897 sexually active women, aged 15-30 yr, for a study investigating the relationship of bacterial vaginosis and acquisition of herpes simplex virus type-2 (HSV-2) infection. A secondary data analysis of the baseline data was undertaken. Primary infertility was defined as having been married for longer than two years, not using contraception and without a child. Logistic regression was used to examine factors associated with primary infertility. Results: The mean age of the women was 25.9 yr (range: 16-30 yr) and the prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. The main factor associated with primary infertility was HSV-2 seropositivity (adjusted odds ratio: 3.41; CI: 1.86, 6.26). Interpretation & conclusions: The estimated prevalence of primary infertility among women in the study was within the range reported by the WHO and similar to other estimates from India. Further research is needed to examine the role of HSV-2 in primary infertility.

Incidence of herpes simplex virus type 2 in young reproductive age women in Mysore, India.

Context: There are sparse data on herpes simplex virus type 2 (HSV-2) infection in India. HSV-2 is one of the most common sexually transmitted infections and the primary cause of genital ulcer disease worldwide. Aim: The aim of this study is to describe the incidence of HSV-2 infection among young reproductive age women in Mysore, India. Setting and Design: Between October 2005 and April 2006, 898 women were enrolled into a prospective cohort study in Mysore, India, and followed quarterly for 6 months. Materials and Methods: An interviewer administered questionnaire was used to collect demographic and social risk factors, and physical examination was conducted for collection of biological specimens to screen for reproductive tract infections at each visit. Serologic testing was conducted for the presence of HSV-2 antibodies using HerpeSelect HSV-2 enzyme-linked immunosorbent assay. Statistical Analysis Used: Data were analyzed using R. Incidence density rates were calculated using Poisson distributions with person-time of follow-up as denominator. Person-time was calculated as time from enrollment until time of first positive HSV-2 test. Results: There were 107 women with HSV-2 antibodies leaving 700 women with negative results at enrollment. The analysis included 696 out of which, there were 36 HSV-2 seroconversions during the study period. The study cohort accumulated roughly 348 woman-years of follow-up, yielding an HSV-2 acquisition rate of 10.4 cases/100 woman-years. All detected infections were asymptomatic. Conclusions: HSV-2 incidence is moderate in this community sample of young reproductive age monogamous women. More research is needed to establish incidence estimates in different Indian settings.

The "AMA-Brazil" cooperative project: a nation-wide assessment of the clinical and epidemiological profile of AIDS-related deaths in Brazil in the antiretroviral treatment era / Projeto cooperativo AMA-Brasil: um estudo nacional do perfil clinico e epidemiológico dos óbitos relacionados à AIDS na era da terapia antirretroviral

The objective of this study was to assess the profile of AIDS-related deaths in the post antiretroviral therapy (ART) scale up period in Brazil. A case-control study was conducted including a nationally probabilistic sample of AIDS deaths and living controls. Data were abstracted from medical records and nation-wide databases of AIDS cases, mortality, ART care, and laboratory testing. Interrupted (adjusted odds ratio - AOR 4.35, 95 percentCI: 3.15-6.00) or no use of ART (AOR 2.39, 95 percentCI: 1.57-3.65) was the strongest predictor of death, followed by late diagnosis (AOR 3.95, 95 percentCI: 2.68-5.82). Criterion other than CD4 < 350 had a higher likelihood of death (AOR 1.65, 95 percentCI: 1.14-2.40). Not receiving recommended vaccines (AOR, 1.76, 95 percentCI: 1.21-2.56), presenting AIDS-related diseases (AOR 2.19, 95 percentCI: 1.22-3.93) and tuberculosis (AOR 1.50, 95 percentCI: 1.14-1.97) had higher odds of death. Being an injecting drug user (IDU) had a borderline association with higher odds of death, while homo/bisexual exposure showed a protective effect. Despite remarkable successes, Brazilians continue to die of AIDS in the post-ART scale up period. Many factors contributing to continued mortality are preventable.

Analisou-se o perfil clínico e epidemiológico dos óbitos relacionados à AIDS no período posterior à implementação da terapia antirretroviral (TARV) no Brasil, em um estudo caso-controle, com amostra representativa de óbitos por AIDS e de pessoas vivendo com AIDS, utilizando dados secundários. Abandono (odds ratio ajustada - AOR = 4,35, IC95 por cento: 3,15-6,00) ou não uso da TARV (AOR = 2,39, IC95 por cento: 1,57-3,65) foi o mais forte preditor de morte, seguido de diagnóstico tardio (AOR = 3,95, IC95 por cento: 2,68-5,82). Critério de definição de AIDS que não o "CD4 < 350" esteve associado a uma maior probabilidade de morte (AOR = 1,65, IC95 por cento: 1,14-2,40). Pacientes que não receberam vacinas recomendadas (AOR = 1,76, 95 por centoCI: 1,21-2,56), apresentando doenças associadas à AIDS (AOR = 2,19, IC95 por cento: 1,22-3,93) e com tuberculose (AOR = 1,50, IC95 por cento: 1,14-1,97), tiveram maior risco de morte. A categoria de exposição UDI apresentou maior chance de óbito. Apesar do sucesso com as introduções precoces da TARV, brasileiros continuaram a morrer de AIDS no período posterior à implementação da terapia, e muitas das causas subjacentes a essa mortalidade são preveníveis.

Assessing risk behaviors and prevalence of sexually transmitted and blood-borne infections among female crack cocaine users in salvador - Bahia, Brazil

Crack cocaine use is associated with risky sexual behaviors and sexually transmitted infections (STIs), including HIV. We investigated sociodemographic and behavioral characteristics and infection rates in female crack cocaine users from impoverished communities of Salvador, Bahia, Brazil. A sample of 125 female crack cocaine users was recruited. Overall, the interviewees had low educational level and high rate of unemployment (close to 90 percent). One-third (37 percent) reported having traded sex for money or drugs, and 58 percent reported that they had not used condoms during intercourse in the last 30 days. The prevalence of infections was low: HIV-1.6 percent; HCV-2.4 percent; HBV- 0.8 percent; HTLV I/II-4.0 percent; and syphilis-4.0 percent. The combination of dire poverty and high prevalence of risk behaviors turn such populations a preferential target of initiatives aiming to reduce drug-related harm and promote social development. Low infection rates should not be viewed with complacency, but as a window of opportunity to implement prevention initiatives and reduce social marginalization.

Acesso a medicamentos para AIDS: lições da iniciativa brasileira / Acess to medicines for AIDS: lessons from the Brazilian initiative

Este artigo situa a inicitaiva brasileira de distribuição de medicamentos para Aids na integração do esforço global para o estabelecimento de politicas que favoreçam o acesso a medicamentos, sobretudo nos paises em desenvolvimento. Para tal, mencionam-se e analisam-se algumas das iniciativas em andamento que visam ampliar o acesso a medicamentos, para pessoas com HIV/AIDS

Vulnerabilidade às infecções pelo HIV, hepatites B e C e sífilis entre adolescentes infratores institucionalizados na cidade de São Paulo, Brasil / Hepatitis B and C and syphilis vulnerability related infections among institutionalized disadvantaged youth in São Paulo-Brazil

Prevalência da infecção pelo HIV, HBV, HCV e sífilis. Identificação do risco de contaminação para estas infecções, tanto pelo comportamento sexual quanto pelo uso de drogas. Identificação de alguns padrões relacionados com a violência

Infección por VIH y tuberculosis en niños / HIV infection and tuberculosis in children

La información sobre el impacto conjunto del virus de inmunodeficiencia humana (VIH) y la tuberculosis (TB) en niños es actualmente muy limitada. El presente estudio determinó la seroprevalencia de anticuerpos al VIH en una muestra consecutiva de 189 niños con TB activa, en edades de 18 meses hasta 5 años, en dos hospitales de Santo Domingo, República Dominicana. Once niños (5.8//, Intérvalos de Confianza al 95//[IC95//]:2.5//,9.2//) resultaron positivos al VIH. Al comparar los niños positivos al VIH con los negativos, los primeros fueron mayormente de raza negra, 8/11 (72.7//) (Diferencia = 48.6//, IC95//: 21.5//, 75.6//; p=0.0008), y entre las edades de 49-60 meses, 5/11 (45.5//) (Diferencia=37.1//, IC 95//:7.3//,66.7//; p=0.0005). No se encontraron diferencias estadísticas entre los niños positivos y negativos al VIH con relación a la historia de contacto con una persona con TB, a la cobertura de inmunización con BCG, a la sintomatología clínica, y al lugar anatómico de la TB. Sin embargo, los niños positivos al VIH reaccionaron en menor proporción a la prueba de tuberculina que los negativos al VIH (Diferencia= -51.5//, IC 95//: -75.3//, -27.7//; p=0.0009). Los resultados de este estudio muestran que la asociación VIH/TB en niños dominicanos no es de gravedad. La aplicación de medidas preventivas contra el VIH y el reforzamiento de los programas de control de ambas entidades deben ser prioridades, como una forma de contribuir a evitar un recrudecimiento del problema. VIH, tuberculosis