Higher Dietary Intake of Animal Protein Foods in Pregnancy Is Associated with Lower Risk of Adverse Birth Outcomes.

BACKGROUND: The prevalence of adverse birth outcomes is highest in resource-limited settings such as sub-Saharan Africa. Maternal consumption of diets with adequate nutrients during pregnancy may protect against these adverse outcomes. OBJECTIVES: The objective was to determine the association between maternal dietary consumption of animal source foods (ASFs) and the risk of adverse birth outcomes among HIV-negative pregnant women in Tanzania. METHODS: Using dietary intake data from 7564 HIV-negative pregnant women, we used Poisson regression with the empirical variance (generalized estimating equation) to estimate the RR of adverse birth outcomes-preterm birth, very preterm birth, small for gestational age (SGA), low birth weight (LBW), stillbirth, and neonatal death-for higher and lower frequency of ASF intake. RESULTS: Median daily dietary intake of animal protein was 17 g (IQR: 1-48 g). Higher frequency of ASF protein intake was associated with lower risk of neonatal death (quartile 4 compared with quartile 1; RR: 0.59; 95% CI: 0.38, 0.90; P-trend = 0.01). Higher fish intake was associated with lower risk of very preterm birth (high tertile compared with low; RR: 0.76; 95% CI: 0.58, 0.99; P-trend = 0.02). Any meat intake was protective of preterm birth (RR: 0.73; 95% CI: 0.65, 0.82; P < 0.001), very preterm birth (P < 0.001), LBW (P < 0.001), and neonatal death (P = 0.01) but was associated with increased risk of SGA (RR:1.19; 95% CI: 1.01, 1.36; P = 0.04). Any egg intake was protective of very preterm birth (RR: 0.50; 95% CI: 0.31, 0.83; P = 0.01) as compared with no egg intake. Finally, any dairy intake was associated with lower risk of preterm birth (RR: 0.82; 95% CI: 0.68, 0.98; P = 0.03) and very preterm birth (RR: 0.53; 95% CI: 0.34, 0.84; P = 0.01). CONCLUSIONS: Higher frequency of dietary intake of ASF is associated with lower risk of adverse birth outcomes in urban Tanzania. Promoting prenatal dietary intake of ASF may improve birth outcomes in this region and similar resource-limited settings.

HIV-1 Nucleic Acids Identify Rectal HIV Exposures in Self-Collected Rectal Swabs, Whereas Y-Chromosome Single Tandem Repeat Mixtures Are Not Reliable Biomarkers of Condomless Receptive Anal Intercourse.

BACKGROUND: To focus interventions, biomarkers of HIV-1 exposure could help in identifying subpopulations at highest risk of acquisition. We assessed whether Y-chromosome single tandem repeat (YSTR) mixtures obtained from rectal swabs could serve as a biomarker of condomless receptive anal intercourse (CRAI) among men who have sex with men and transgender women and evaluated the feasibility of detecting HIV-1 virions to assess exposures. METHODS: Twenty-nine sexually active HIV-seronegative men who have sex with men and one transgender woman from New York City answered on-site and mobile app sexual behavior questionnaires. They were randomized to collecting self-administered rectal swabs every morning or after receptive anal intercourse (RAI). YSTR profiles were assessed from blood sample and swabs; HIV-1 exposure was measured by conducting quantitative polymerase chain reaction in swabs. RESULTS: After 2 months, the daily mobile survey had 135%-201% more instances of anal sex acts and 170%-193% more RAI than on-site surveys. Daily mobile reporting had 11%-35% less CRAI events than those reported on-site (Pdaily = 0.001; Pper-sex = 0.047). The daily swabbing arm reported less RAI (P < 0.001) and CRAI (P < 0.038) and had 2.95 lower odds of detecting YSTR mixtures (P = 0.021) than the per-sex-event arm. Surprisingly, YSTR detection was not significantly modified by report of bowel movements and lubricant, enema, or condom use. No participant became HIV-1 infected, yet HIV-1 total nucleic acids were detected in 6 independent episodes of CRAI in 2 participants taking pre-exposure prophylaxis. CONCLUSIONS: YSTR mixtures demonstrated 80% specificity but only 30% sensitivity as a biomarker of CRAI in self-collected rectal swabs. However, detection of HIV-1 exposures in self-collected swabs may help in identifying those needing further HIV risk reduction strategies.

Real world survival data of a rare malignancy: Anal cancer results in HIV negative patients from Turkey.

BACKGROUND/AIMS: An organ preservation approach using chemoradiotherapy has been established for anal cancer. This retrospective cohort study aimed to define the clinico-demographic characteristics and outcomes of cases of human immunodeficiency virus (HIV)-negative anal carcinoma during a period of 20 years in a single comprehensive cancer institute. MATERIALS AND METHODS: This was a single-center retrospective cohort study of patients who were treated between January 1995 and January 2015. The primary outcome measures that were investigated included overall survival (OS), progression-free survival (PFS), colostomy rates, and colostomy-free survival (CFS). RESULTS: A total of 28 patients who were principally treated with standard 5-fluorouracil + mitomycin combination chemoradiotherapy were eligible for analysis. The 3- and 5-year PFS rates were 92.4% and 63%, respectively. The lower T stage was found to be associated with a prolonged PFS (p=0.001). The 3- and 5-year CFS rates were 84.3% and 74.9%, respectively. A longer CFS was observed with lower T stages (p=0.05). At the last follow-up, 75% of the patients with anal cancer were alive, and 71.4% of the patients were disease free. The median OS was not reached with a median follow-up of 54 months (range, 6-115 months). The 3- and 5-year OS rates were 82% and 71.1%, respectively. No late toxicity was observed during the follow-up period. DISCUSSION: The short- and long-term prognoses of HIV-negative patients with anal squamous cell carcinoma were good, and low-grade toxicity was rare, thereby demonstrating that these patients can be successfully treated in a real-life setting with favorable outcomes.

Longitudinal intra-individual variability in neuropsychological performance relates to white matter changes in HIV.

OBJECTIVES: Recent studies suggest that intraindividual variability (IIV) of neuropsychological performance may be sensitive to HIV-associated neurologic compromise. IIV may be particularly dependent upon the integrity of frontal-subcortical systems, and therefore may be a meaningful phenotype in HIV. We examined the relationship between change in IIV and white matter integrity among HIV seropositive (HIV+) and HIV seronegative (HIV-) individuals. METHOD: The sample consisted of 38 HIV+ participants and 26 HIV- control participants who underwent neuroimaging and a neuropsychological evaluation at baseline and at 2-year follow-up evaluation. RESULTS: Among HIV+ participants, increases in IIV (greater dispersion) were related to lower fractional anisotropy (FA) values in the anterior thalamic radiations (ATR) and the superior longitudinal fasciculus (SLF). Changes in mean-level global cognitive functioning were not significantly related to white matter integrity. Additionally, there was a significant Group × IIV interaction effect in the SLF demonstrating that the relationship between IIV and white matter integrity was specific to HIV. CONCLUSIONS: Overall, findings suggest that IIV may be more sensitive, relative to mean-level global cognitive functioning, in the detection of neurologic compromise among HIV+ individuals. (PsycINFO Database Record

Factors Associated with Mood Disorder Diagnosis Among a Population Based Cohort of Men and Women Living With and Without HIV in British Columbia Between 1998 and 2012.

Using data from the Comparison of Outcomes and Service Utilization Trends (COAST) study we examined factors associated with mood disorder diagnosis (MDD) among people living with HIV (PLHIV) and HIV-negative individuals in British Columbia, Canada. MDD cases were identified between 1998 and 2012 using International Classification of Disease 9 and 10 codes. A total of 491,796 individuals were included and 1552 (23.7%) and 60,097 (12.4%) cases of MDD were identified among the HIV-positive and HIV-negative populations, respectively. Results showed HIV status was associated with greater odds of MDD among men and lower odds among women. Among PLHIV, MDD was significantly associated with: identifying as gay, bisexual or other men who have sex with men compared to heterosexuals; higher viral load; history of injection drug use; and concurrent anxiety, dysthymia, and substance use disorders. Findings highlight the need for comprehensive and holistic HIV and mental health care.

A Case of Plasmablastic Lymphoma Achieving Complete Response and Durable Remission after Lenalidomide-Based Therapy.

BACKGROUND: Plasmablastic lymphoma (PBL) is an uncommon variant of diffuse large B-cell lymphoma that is characterized by its plasmacytoid features, aggressive tendencies, and frequent association with human immunodeficiency virus (HIV) infection or other immunocompromised states. Multi-agent, intensive chemotherapy regimens are recommended as first-line treatment by the National Comprehensive Cancer Network. However, the toxicity of these regimens is high and prognosis remains poor. CASE REPORT: We report a patient with HIV-negative PBL who achieved complete response and durable remission using a lenalidomide-based chemotherapy regimen as first-line therapy. CONCLUSION: Cyclophosphamide, lenalidomide, dexamethasone (CRD) may provide an alternative initial therapeutic option for patients with PBL who cannot tolerate the intensive chemotherapy regimens currently recommended.

Use of a Prospective Sex Diary to Study Anal Lubricant and Enema Use Among High Risk Men Who Have Sex With Men-Implications for Human Immunodeficiency Virus Prevention.

Longitudinal data on episodes of receptive anal intercourse (RAI), lubricant, and enema use in 41 sexually active men who have sex with men were collected using a prospective sex diary. Data on 550 episodes of RAI showed that lubricants were used in 489 (88.9%) of 550 episodes and enemas were used in 165 (30%) of 550 RAI episodes.

'We keep her status to ourselves': experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine.

In HIV-discordant relationships, the HIV-negative partner also carries the burden of a stigmatised disease. For this reason, couples often hide their HIV-discordant status from family, friends and community members. This perpetuates the silence around HIV-discordant relationships and impacts on targeted HIV prevention, treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine. During 2008, HIV-discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire, while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa, 10 from Tanzania, and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner, few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip, rumours and name-calling, and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system.

Selenium status and infant birth weight among HIV-positive and HIV-negative pregnant women in Lagos, Nigeria.

BACKGROUND: During pregnancy, selenium deficiency and reduced antioxidant activities may result in adverse perinatal outcome such as low birthweight, which is associated with significant perinatal morbidity and mortality. Many studies have reported conflicting findings on the relationship between maternal selenium status and infant birth weight. OBJECTIVE: This study is to determine the relationship between maternal serum selenium concentration and infant birthweight in HIV-positive and HIV-negative pregnant women at term. METHODS: A cross-sectional study carried out among HIV-positive and HIV-negative pregnant women at term. Participants were recruited from the antenatal clinic at the Lagos University Teaching Hospital. After obtaining an informed consent, participants were interviewed using a structured questionnaire. Five milliliters of venous blood sample was collected from each participant for estimation of selenium levels using the Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method. At delivery, the infant birth weights were measured using a standard infant weighing scale. RESULTS: Of the 240 participants, data were complete for analysis in 214 (89.2%) of the participants. HIV-positive women had significantly lower mean serum selenium concentration when compared with HIV-negative women (33.7 +/- 22.2 pg/L versus 83.6 +/- 18.7 pg/L; p<0.01). Compared with HIV-negative women, the mean birth weight of infants of HIV positive women was significantly lower (2952 +/- 572 g versus 3392 +/- 452 g; p<0.01). There was no significant association between maternal serum selenium levels at term and infant birth weight in both groups. CONCLUSION: HIV-positive pregnant women had a lower mean serum selenium level and their infants had a lower mean birth weight, when compared to HIV-negative pregnant women. However, no significant association was found between maternal serum selenium concentration and birth weight in both groups.

Anal condyloma treatment and recurrence in HIV-negative men who have sex with men.

BACKGROUND: Men who have sex with men have increased prevalence of both human papillomavirus and anogenital condyloma. OBJECTIVE: Risk factors for multiple treatment and recurrence of anal condyloma were examined. DESIGN: This is a retrospective study of HIV-negative men who have sex with men who were treated for anal condyloma. SETTINGS: This study was conducted in a private surgical practice. PATIENTS: The patients were HIV-negative men who have sex with men, aged 18 years or older. INTERVENTION(S): Ablation with electrocautery or CO2 laser was performed, as well as excision and topical imiquimod condyloma treatment adjuvant. MAIN OUTCOME MEASURES: Primary clearance, defined as 4 months of condyloma-free survival posttreatment, and recurrence, defined as any anal condyloma diagnosis after primary clearance. RESULTS: Of 231 participants, 207 achieved primary clearance (median age, 32.0 years) and were followed (median, 18.2 months) after primary treatment. Most had intra-anal and perianal condyloma (56%), were treated with electrocautery ablation (79.2%), and required 1 treatment (range, 1-6) for clearance. There were 57 recurrences (median, 12 months). One-third each had minimal, moderate, or extensive disease. Forty-six percent of patients received imiquimod posttreatment adjuvant. High-grade dysplasia was found in 31% at presentation and 43% during follow-up. Factors associated with requiring multiple treatments for clearance were participants having moderate disease (adjusted odds ratio, 6.0 (1.7-21.4)) and receiving imiquimod adjuvant (adjusted odds ratio, 4.7 (2.0-10.6)). No single factor predicted recurrence, but those with moderate disease experienced recurrences significantly sooner (median, 25 months of follow-up). LIMITATIONS: This was a retrospective chart review, it was limited to a single practice, and it excluded those who did not achieve primary clearance. CONCLUSIONS: Most men who have sex with men have intra-anal and perianal condyloma and concomitant high-grade dysplasia is common. Most achieved clearance with 1 treatment. Having both intra-anal and perianal condyloma, increased severity of disease, and imiquimod adjuvant were significant predictors of requiring multiple treatments for clearance. No identified risk factors proved a significant predictor of recurrence.

Does HIV status affect the aetiology, bacterial resistance patterns and recommended empiric antibiotic treatment in adult patients with bloodstream infection in Cambodia?

OBJECTIVE: The microbiologic causes of bloodstream infections (BSI) may differ between HIV-positive and HIV-negative patients and direct initial empiric antibiotic treatment (i.e. treatment before culture results are available). We retrospectively assessed community-acquired BSI episodes in adults in Cambodia according to HIV status for spectrum of bacterial pathogens, antibiotic resistance patterns and appropriateness of empiric antibiotics. METHODS: Blood cultures were systematically performed in patients suspected of BSI in a referral hospital in Phnom Penh, Cambodia. Data were collected between 1 January 2009 and 31 December 2011. RESULTS: A total of 452 culture-confirmed episodes of BSI were recorded in 435 patients, of whom 17.9% and 82.1% were HIV-positive and HIV-negative, respectively. Escherichia coli accounted for one-third (n = 155, 32.9%) of 471 organisms, with similar rates in both patient groups. Staphylococcus aureus and Salmonella cholereasuis were more frequent in HIV-positive vs. HIV-negative patients (17/88 vs. 38/383 (P = 0.02) and 10/88 vs. 5/383 (P < 0.001)). Burkholderia pseudomallei was more common in HIV-negative than in HIV-positive patients (39/383 vs. 2/88, P < 0.001). High resistance rates among commonly used antibiotics were observed, including 46.6% ceftriaxone resistance among E. coli isolates. Empiric antibiotic treatments were similarly appropriate in both patient groups but did not cover antibiotic-resistant E. coli (both patient groups), S. aureus (both groups) and B. pseudomallei (HIV-negative patients). CONCLUSION: The present data do not warrant different empiric antibiotic regimens for HIV-positive vs. HIV-negative patients in Cambodia. The overall resistance rates compromise the appropriateness of the current treatment guidelines.

Histopathologic outcomes and clinical correlations for high-risk patients screened with anal cytology.

OBJECTIVE: Anal cytologic testing is being increasingly used as a preventive screening test in high-risk populations. We document anal cytology results, correlating HIV test results, and histopathologic follow-up outcomes from a large integrated health system which recently implemented anal screening. STUDY DESIGN: Anal Pap tests between May 2007 and August 2009 were studied and correlated with HIV test histories and follow-up histopathologic diagnoses. RESULTS: 688 anal cytologic tests were identified with 7.4% reported as unsatisfactory; 72% of anal cytologic tests were abnormal; 91% of patients were HIV positive. The HIV-positive rate and likelihood of high viral load were both significantly greater among patients with abnormal anal cytology than among patients with negative anal cytology, but did not vary significantly among patients with different categories of abnormal anal cytology. For 459 patients with abnormal anal cytology, 198 had anal biopsies. For patients with abnormal anal cytology findings of ASC-US (atypical squamous cells of undetermined significance), LSIL (low-grade squamous intraepithelial neoplasia), ASC-H (atypical squamous cells, cannot exclude high-grade squamous lesion), and HSIL (high-grade squamous intraepithelial neoplasia), histopathologic intraepithelial neoplasia (AIN)2/3 or 2/3+ diagnoses were established in 46.5, 56.6, 65, and 80.8%, respectively. CONCLUSIONS: Patients with any level of abnormal anal cytology result are at significant risk of the presence of histopathologically verifiable high-grade anal intraepithelial lesions. More specific markers for identifying patients at highest risk of progression to invasive anal carcinoma are needed.

Evolução clínica dos pacientes vítimas de trauma com e sem infecção por HIV admitidos no Hospital Central de Maputo, de Junho a Setembrode 2010 / Clinical evolution of patients victims of trauma with and without HIV infection admitted to the Maputo Central Hospital, from June to September 2010

A infecção pelo Vírus da Imunodeficiência Adquirida (HIV) é um problema importante de Saúde Pública em Moçambique onde a prevalência é uma das mais elevadas do mundo. O Trauma é uma das principais causas de morte particularmente em adultos jovens e adolescentes, sendo por muitos considerada uma doença negligenciada. Há pouca informação sobre as características dos pacientes com trauma admitidos através dos nossos Serviços de Urgência (SUR) e sobre a prevalência da infecção por HIV nos pacientes traumatizados; sabe-se que esta está relacionada a uma pobre evolução clínica em pacientes gravemente traumatizados. Objectivos: Caracterizar o perfil dos pacientes admitidos por trauma, determinar a prevalência da infecção por HIV nos mesmos e avaliar a influência desta infecção e contagem das células CD4 (CcCD4) na sua evolução clínica. Métodos: Estudo observacional tipo cohorte prospectivo, realizado no Hospital Central de Maputo entre Maio e Setembro de 2010. Foram estudados 441 pacientes vítimas de trauma admitidos no SUR deste hospital. Os pacientes foram testados para HIV: aos seropositivos HIV (PHP) foi feita a CcCD4. Procedeu-se à recolha da informação relativa aos dados demográficos, sinais vitais, mecanismos de lesão, áreas com lesão, antecedentes clínicos, e foram calculadas escalas de gravidade de trauma (RTS - A escala revista de trauma e ISS - Escala de gravidade das lesões). A evolução clínica foi analisada com base nas complicações desenvolvidas durante o internamento, dias de internamento no hospital (DIH) e cuidados intensivos (DICI), e na mortalidade. Os resultados foram comparados de acordo com o estado serológico para HIV e CcC4. Resultados: Dos pacientes admitidos 73,5% eram do sexo masculino. A média das idades foi de 31,6 anos, com 85,3% pacientes abaixo dos 45 anos. Os acidentes de viação (AV) foram o principal mecanismo de lesão sendo 57,8% peões e 30,1% passageiros. Os traumas ocorreram principalmente na via pública (60,0%): o consumo de álcool foi evidenciado em 38,4% das admissões. A maioria dos pacientes apresentavam trauma ligeiro e o tempo médio de internamento foi de 8 dias (±10,67). Ocorreram 29 óbitos, sobretudo por AV (58,6%). A prevalência da infecção por HIV foi de 25,9%, afectando 22,5 % homens e 35,0% mulheres (p=0,0080). Anteriormente à admissão apenas 8,8% dos PHP havia feito o teste (p<0,001), e 55,0% destes tinham CD4<350 céls/mm3. Os mecanismos de lesão foram semelhantes entre os dois grupos (PHP e HIV seronegativos - PHN) à excepção das mordeduras humanas (6,1% PHP vs 0,9% PHN; p=0,026). Os PHP apresentaram mais complicações infecciosas ou não, contudo, os dois grupos tiveram RTS, ISS, DIH, DICI e mortalidade semelhantes. O CD4 não influenciou nos dias de internamento nem na mortalidade. Conclusões: Os PHP desenvolveram mais complicações infecciosas, contudo a infecção por HIV e a CcCD4 não influencia os DIH, DICI nem a mortalidade pós trauma. Recomenda-se aconselhamento e testagem voluntária para HIV neste grupo de pacientes, pois estes podem beneficiar de cuidados x adicionais como a terapia anti-retroviral. Julga-se importante a implementação dum sistema de vigilância intra-hospitalar para o trauma.

The Infection with Human Immunodeficiency Virus (HIV) is an important public health problem in Mozambique where the prevalence of this infection is one of the highest in the world. Trauma is a leading cause of death mainly among young adults and adolescents, for several regarded as a neglected disease. Information about the characteristics of trauma patients admitted through our emergency service (ES) and on the prevalence of HIV infection in this group of patients is scarce, and it is known that this is related to a poor clinical outcome in severely traumatized patients. Aims: To characterize the profile of trauma patients admitted, to determine the prevalence of HIV infection among them, and to evaluate the influence of this infection and CD4 count (CD4c) in the clinical outcome after trauma. Methods: An observational prospective cohort study, conducted at the Maputo Central Hospital (HCM) between May and September 2010. We studied 441 trauma patients admitted in this hospital through the ES. Patients were evaluated for HIV: in HIV positives patients (PHP) CD4c was done. Collection of information on demographics, vital signs, mechanisms of injury, areas of injury and medical history was done, and Injury severity scores (RTS - The revised trauma score and ISS ­ Injury severity score) were calculated. The clinical outcome based on the complications developed during hospitalization, hospital length of stay (HLOS), intensive care length of stay (ILOS) and mortality was analyzed. The results were compared according to HIV status and level of CD4c. Results: of the studied patients, 73.5% were male. The mean age was 31.6 years, and 85.3% of the patients were below 45 years age. Road traffic accidents (RTA) were the major mechanism of injury, affecting 57.8% pedestrians and 30.1% passengers. The injuries occurred mostly on the streets (60.0%), alcohol consumption was found in 38.4% of admissions. Most patients had mild trauma and the average hospital stay was 8 days (± 10.7). Death have occurred in 29 patients, mainly by RTA (58.6%).The overall HIV infection prevalence was 25.9% (22.5% in men and 35.0% in women, with p = 0.0080). Only 8.8% of PHP had done the test prior to admission, (p <0,001), and 55.0% of these had CD4 <350 cells/mm3. The mechanisms of injury were similar between the two groups (PHP and HIV negative - NHP) except for human bites (6.1% PHP vs 0.9% NHP, p = 0.026). PHP had more infectious and non infectious complications; however, the two groups (PHP and NHP) had similar RTS, ISS, HLOS and mortality. The CD4 did not affect HLOS, ILOS or mortality. Conclusions: PHP developed more infectious complications; however HIV infection and CD4c xi did not influence HLOS, ILOS or mortality after trauma. Counseling and voluntary testing for HIV is recommended in this group of patients since they may benefit from additional care such as antiretroviral therapy. It is deemed important to implement an in-hospital surveillance system for trauma.

Effect of antacids on the pharmacokinetics of raltegravir in human immunodeficiency virus-seronegative volunteers.

Raltegravir's divalent metal ion chelating motif may predispose the drug to interactions with divalent cations. We determined whether a divalent cation-containing antacid interacted with raltegravir. Twelve HIV-1-seronegative subjects were enrolled in this randomized, prospective, crossover study of single-dose raltegravir (400 mg) with and without an antacid. Subjects underwent two intensive pharmacokinetic visits in the fasted state separated by a 5- to 12-day washout period. With simultaneous antacid administration, time to peak raltegravir concentration occurred 2 h sooner (P = 0.002) and there was a 67% lower raltegravir concentration at 12 h postdose (P < 0.0001) than with administration of raltegravir alone. The raltegravir area under the-concentration-time curve from 0 to 12 h and maximum concentration were unchanged with the addition of an antacid. Studies are needed to determine the clinical relevance of this interaction, whether it remains after multiple dosing to steady state, whether it is mitigated by temporal separation, and whether raltegravir interacts with divalent cation-containing vitamins, supplements, or foods.

Study of HIV-1 subtypes in serodiscordant couples attending an integrated counselling and testing centre in Mumbai using heteroduplex mobility analysis and DNA sequencing.

AIMS: To determine the prevalent subtypes of HIV-1 in serodiscordant couples. SETTING: Integrated Counselling and Testing Centre (ICTC), Department of Microbiology. STUDY DESIGN: Prospective pilot study. PARTICIPANTS: Thirty HIV-1 serodiscordant couples. INCLUSION CRITERIA: a) Documentation of HIV-1 infection in one partner and seronegative status in the other, current history of continued unprotected sexual activity within the partnership, demonstration that they have been in a partnership for at least 1 year and are not currently on highly active antiretroviral therapy HAART; b) willingness of both partners to provide written informed consent including consent to continued couple counselling for 3 months. MATERIALS AND METHODS: HIV-1 subtyping was carried out by heteroduplex mobility analysis (HMA) by amplifying env region; and DNA sequencing by amplifying gag region. RESULTS: HIV-1 env gene was amplified successfully in 10/30 samples; gag gene, in 25/30 samples; and both env and gag gene were amplified successfully in 5/30 samples. HIV-1 subtype C was detected from 21 samples; subtype B, from 7; and subtype A, from 2. Sample from 1 positive partner was detected as subtype C by env HMA and subtype B by gag sequencing. CONCLUSION: HIV-1 subtype C was found to be the predominant subtype of HIV-1 in serodiscordant couples attending our ICTC, followed by HIV-1 subtype B and HIV-1 subtype A, respectively. DNA sequencing was found to be the most reliable method for determining the subtypes of HIV-1.

Septicaemia in a population-based HIV clinical cohort in rural Uganda, 1996-2007: incidence, aetiology, antimicrobial drug resistance and impact of antiretroviral therapy.

OBJECTIVES: To describe the incidence and aetiology of septicaemia, and antimicrobial drug resistance in HIV-infected and uninfected individuals, and the impact of antiretroviral therapy (ART) on septicaemia. METHODS: Between 1996 and 2007, we followed up a rural population-based cohort of HIV-infected and uninfected participants. The aetiology and incidence of septicaemia, and antimicrobial drug resistances were determined. ART became available in 2004, and its impact on the incidence of septicaemia was examined. RESULTS: The overall septicaemia incidence (per 1000 pyrs) was 32.4 (95% CI 26.2-40.6) but was only 2.6 (95% CI 1.3-6.2) in HIV-negative patients and 67.1 (95% CI 53.4-85.4) in HIV-positive patients not on ART. Among those on ART, the overall incidence was 71.5 (95% CI 47.1-114.3), although it was 121.4 (95%CI 77.9-200.4) in the first year on ART and 37.4 (95%CI 18.9-85.2) in the subsequent period. Septicaemia incidence was significantly associated with lower CD4 counts. The commonest isolates were Streptococcus pneumoniae (SPN, n = 68) and Non-typhi salmonellae (NTS, n = 42). Most SPN isolates were susceptible to ceftriaxone and erythromycin, while resistance to cotrimoxazole and penicillin was common. All NTS isolates were susceptible to ciprofloxacin, but resistance to cotrimoxazole and chloramphenicol was common. CONCLUSIONS: Septicaemia incidence was higher in HIV-infected than in HIV-uninfected participants, and it remained high for some time among those who started ART. Starting ART earlier at higher CD4 counts is likely to lead to lower septicaemia incidence. Both SPN and NTS, the commonest isolates, were resistant to most commonly available antimicrobials. Blood culture laboratory surveillance systems to monitor antibiotic susceptibility and inform treatment guidelines are needed in Africa.

[No obvious difference in Streptococcus pneumoniae antibiotic resistance profiles--isolates from HIV-positive and HIV-negative patients]. / Vergleichbare Antibiotikaresistenz von Pneumokokkenisolaten HIV-positiver und -negativer Patienten.

BACKGROUND AND PURPOSE: HIV patients are overexposed to hospital environment, immune suppression, and antibiotic prophylaxes. Therefore, with HIV positive patients an increased risk for resistant bacterial rods is to be expected. The purpose of this case-control study was to determine the susceptibility patterns of pneumococci from adult patients in relation to their HIV status and to compare both patient groups. PATIENTS AND METHODS: Between January 2001 and December 2005, samples from internal medicine patients of one university hospital laboratory were investigated on culture of Streptococcus pneumoniae and in case of a positive vial, a resistance test was done by agar diffusion method. All patients with culture-confirmed infection due to pneumococci underwent a standardized retrospective evaluation in regard to demographic and clinical characteristics including HIV status. RESULTS: A total amount of 135 Streptococcus pneumoniae cultures could be assigned to 64 HIV-positive (A) and 71 HIV-negative patients (B), with susceptibility results for 134 isolates. Full susceptibility was seen in 44 (69.8% [A]) versus 42 (59.2% [B]) samples, reduced susceptibility ("intermediate-susceptible") was found in eight (12.7% [A]) versus 17 (23.9% [B]). Eleven (17.5% [A]) and twelve (16.9% [B]), respectively, out of all pneumococci were tested resistant to at least one antibiotic. Among these, resistance to erythromycin was most relevant (11.1% [A] and 11.3% [B]). None of the tested rods was resistant to penicillin. All differences between groups for susceptibility testing were not found significant. HIV-negative patients were significantly older, needed more often hospitalization and intensive care, and cultures for pneumococci were more frequently positive in primary sterile materials, such as cerebrospinal fluid and blood. The difference concerning death within 28 days following positive sample was just not significant as well as in immune suppression status of patients. HIV patients experienced more frequently an infection relapse and were more frequently smokers. CONCLUSION: No obvious difference in pneumococci resistance patterns was observed between HIV-positive and HIV-negative adult patients. The absence of resistance to penicillin underscores the importance of beta-lactams in case of typical community-acquired pneumonia; therefore, this class of antibiotics should be included in treatment guidelines as first-line drugs also for HIV patients. HIV-negative controls of this study were more aged and suffered from a higher morbidity, however, the fact that they were not significantly less immune suppressed may be special character of a university hospital control patient group. HIV patients presented in an earlier stage of their pneumococcal disease, probably due to a direct access to tertiary hospital medical supply. A higher relapse rate underscores the importance of pneumococcal vaccination for HIV patients.

HIV-positive and HIV-negative consumers accept an instant soy maize porridge

The objective of this study was to assess consumer acceptability; preference and consumption intent of an instant soy maize porridge; compared to an instant plain maize porri- dge; in order to determine the successful inclusion of the soy maize porridge as a food supplement for HIV subjects in a subsequent nutrition intervention trial; to improve their nutritional status. A 5-point hedonic and food action rating scale was used for this purpose. HIV-positive (n=57) and HIV-negative (n=47) subjects were recruited on a basis of availability and willingness to participate. Long-term acceptability and compliance of HIV-positive consumers (n=9) was assessed after three and five months. Analysis of variance (ANOVA); Tukey's multiple comparison test and T-tests (p=0.05) were performed. Overall; consumers found the soy maize porridge significantly more acceptable; preferred it to; and also intended to consume it more often than the plain maize porridge. There were no significant differences between the HIV-positive and HIV-negative group regarding acceptability; preference and consumption intent. After three and five months; the HIV-positive consumers (n=9) did not find acceptability of the soy maize porridge significantly different from the first evaluation. It therefore had the potential to be included successfully in the nutrition intervention trial. The current study emphasises the need for sensory evaluation of food products prior to including them in intervention studies; to assess consumers' acceptance of them

Vitamins and perinatal outcomes among HIV-negative women in Tanzania.

BACKGROUND: Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes. METHODS: In a double-blind trial in Dar es Salaam, Tanzania, we randomly assigned 8468 pregnant women (gestational age of fetus, 12 to 27 weeks) who were negative for human immunodeficiency virus infection to receive daily multivitamins (including multiples of the recommended dietary allowance) or placebo. All the women received prenatal supplemental iron and folic acid. The primary outcomes were low birth weight (<2500 g), prematurity, and fetal death. RESULTS: The incidence of low birth weight was 7.8% among the infants in the multivitamin group and 9.4% among those in the placebo group (relative risk, 0.82; 95% confidence interval [CI], 0.70 to 0.95; P=0.01). The mean difference in birth weight between the groups was modest (67 g, P<0.001). The rates of prematurity were 16.9% in the multivitamin group and 16.7% in the placebo group (relative risk, 1.01; 95% CI, 0.91 to 1.11; P=0.87), and the rates of fetal death were 4.3% and 5.0%, respectively (relative risk, 0.87; 95% CI, 0.72 to 1.05; P=0.15). Supplementation reduced both the risk of a birth size that was small for gestational age (<10th percentile; 10.7% in the multivitamin group vs. 13.6% in the placebo group; relative risk, 0.77; 95% CI, 0.68 to 0.87; P<0.001) and the risk of maternal anemia (hemoglobin level, <11 g per deciliter; relative risk, 0.88; 95% CI, 0.80 to 0.97; P=0.01), although the difference in the mean hemoglobin levels between the groups was small (0.2 g per deciliter, P<0.001). CONCLUSIONS: Multivitamin supplementation reduced the incidence of low birth weight and small-for-gestational-age births but had no significant effects on prematurity or fetal death. Multivitamins should be considered for all pregnant women in developing countries. (ClinicalTrials.gov number, NCT00197548 [ClinicalTrials.gov].).

Effect of haematinic supplementation and malaria prevention on maternal anaemia and malaria in western Kenya.

OBJECTIVE: To evaluate the effect of routine antenatal haematinic supplementation programmes and intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) in Kenya. METHODS: Anaemia [haemoglobin (Hb) <11 g/dl), severe anaemia (Hb <8 g/dl) and placental malaria were compared among women with known HIV status who delivered at a provincial hospital after study enrolment in the third trimester during three consecutive periods: period 1, no routine intervention (reference); period 2, routine haematinic supplementation (60 mg elementary iron three times/day, folic acid 5 mg once daily) and period 3, haematinics and IPT with SP. RESULTS: Among 3108 participants, prevalence of placental malaria, anaemia and severe anaemia postpartum was 16.7%, 53.6% and 12.7%, respectively. Compared with period 1, women in period 2 were less anaemic [adjusted odds ratio (AOR), 95% confidence interval anaemia: 0.56, 0.47-0.67; severe anaemia 0.37, 0.28-0.49] and shared a similar prevalence of placental malaria (AOR 1.07, 0.86-1.32). Women in period 3 were also less anaemic (AOR anaemia: 0.43, 0.35-0.53 and severe anaemia: 0.43, 0.31-0.59), and had less placental malaria (AOR 0.56, 0.42-0.73). The effect of intervention did not differ significantly by HIV status. CONCLUSION: The haematinic supplementation programme was associated with significant reductions in anaemia in HIV-seropositive and HIV-seronegative women. The subsequent introduction of IPT was associated with halving of malaria, but no additional haematological benefit over haematinics.