Efficacy of antiretroviral therapy in Africa: effect on immunological and virological outcome measures -- a meta-analysis.

This study is a systematic literature review exploring the efficacy of antiretroviral therapy (ART) in Africa through a meta-analysis of immunological and virological outcome measures at baseline and six subsequent time points. A literature search was conducted through two databases and references of relevant papers searched. The inclusion criteria were papers with data from the African continent with predominantly an adult population, who were ART naïve and human immunodefieciency virus-1-positive, data on the CD4 count and/or percentage undetectable viral load (UDVL) at a subsequent time-point following ART initiation. The search identified 368 papers. Of these 320 were excluded by title and abstract, 48 papers were accessed with a further 19 papers then excluded. Twenty-nine papers from 12 countries were included in the meta-analysis. All papers showed evidences of Grade III or IV. The mean CD4 count (cells/mm(3)) at baseline was 141.0 and viral load was 5.2 log(10). The mean CD4 count was 243.8, 248.9, 277.1, 274.1, 298.4, 374 at 3, 6, 12, 18, 24 and >24 months, respectively. The mean percentage with UDVL was 73.3, 74.7, 66.9, 68.1, 64.6, 73.5 at 3, 6, 12, 18, 24 and >24 months, respectively. In conclusion, the meta-analysis provides evidence that ART increases the CD4 count from three months until three years, and the majority of subjects had an UDVL (<400 copies/mL) at each analysed time-point. Though the grade of evidence is low, this analysis suggests that ART can be provided successfully within the continent of Africa even with the limitations of a resource-poor setting.

Outcome of partner notification of HIV infection in a provincial clinic in East Anglia, UK.

A retrospective study of outcome of partner notification and contact tracing in the cohort of newly diagnosed HIV/AIDS patients seen in the Bure Clinic from 1997 to 2004 was undertaken. There were 17 women, median age (years) 31, range (18-44) and 43 men, median age (years) 37, range (3-61). Self-reported ethnic groups were 17 (28.3%) Africans, two (3.3%) Asians and 41 (68.3%) Caucasians. Partner notification index was 51.7% (95% confidence interval [CI] 38.4-64.8%). Africans and Asians (76%) were more likely to bring in their partners than Caucasians (39%) and this was statistically significant (x2 = 8.63, P = 0.01). The Caucasians (61%), who did not bring in their partner, were more likely to be oil workers who had acquired their infection in Africa and Asia (likelihood ratio 11.59, P = 0.02), confirmed by their viral clade. In our cohort, Caucasian heterosexual men, mostly oil workers who acquire their infections elsewhere, contribute to the low partner notification index. To date, non-B clade virus has not been transmitted locally among newly diagnosed patients seen from our low sero-prevalence catchment population.

Unilateral gonococcal ophthalmia without genital infection: an unusual presentation in an adult.

We present the case of unilateral gonococcal ophthalmia without concomitant genital infection seen in an adult, with the potential for visual impairment if not adequately recognized and promptly treated.