Killer-cell Immunoglobulin-like Receptor (KIR) gene profiles modify HIV disease course, not HIV acquisition in South African women.

BACKGROUND: Killer-cell Immunoglobulin-like Receptors (KIR) interact with Human Leukocyte Antigen (HLA) to modify natural killer- and T-cell function. KIR are implicated in HIV acquisition by small studies that have not been widely replicated. A role for KIR in HIV disease progression is more widely replicated and supported by functional studies. METHODS: To assess the role of KIR and KIR ligands in HIV acquisition and disease course, we studied at-risk women in South Africa between 2004-2010. Logistic regression was used for nested case-control analysis of 154 women who acquired vs. 155 who did not acquire HIV, despite high exposure. Linear mixed-effects models were used for cohort analysis of 139 women followed prospectively for a median of 54 months (IQR 31-69) until 2014. RESULTS: Neither KIR repertoires nor HLA alleles were associated with HIV acquisition. However, KIR haplotype BB was associated with lower viral loads (-0.44 log10 copies/ml; SE = 0.18; p = 0.03) and higher CD4+ T-cell counts (+80 cells/µl; SE = 42; p = 0.04). This was largely explained by the protective effect of KIR2DL2/KIR2DS2 on the B haplotype and reciprocal detrimental effect of KIR2DL3 on the A haplotype. CONCLUSIONS: Although neither KIR nor HLA appear to have a role in HIV acquisition, our data are consistent with involvement of KIR2DL2 in HIV control. Additional studies to replicate these findings are indicated.

Strengthening HIV services for pregnant women: an opportunity to reduce maternal mortality rates in Southern Africa/sub-Saharan Africa.

Reliable data from South Africa emanating from WHO recommendations for the Safe Motherhood programme underscores HIV/AIDS as the most common cause of maternal deaths. The strengthening of HIV services for pregnant women especially in countries with a high burden of HIV infection will reduce HIV-related and un-related maternal mortality rates. High-quality and complete data on maternal deaths is a critical foundation for reliably monitoring temporal trends in maternal deaths, and causes thereof, but needs substantial strengthening in many resource-constrained settings. HIV/AIDS is an increasing contributor to direct and indirect causes of maternal deaths in sub-Saharan Africa. A review of published data on maternal deaths and its association with HIV shows that reliable data come from the Confidential Enquiries into Maternal Deaths from South Africa, population-based surveys in sentinel populations, and facility-based data. Despite an increase in knowledge of the HIV status of pregnant women and the initiation of antiretroviral treatment, reversals in trends towards increased maternal deaths are not being observed. The strengthening of HIV services provides an opportunity to alter HIV epidemic trajectories and reduce maternal deaths.

Health Care Attendance Patterns By Pregnant Women In Durban; South Africa

"Background: High rates of perinatal mortality and morbidity and maternal mortality in South Africa remain a major problem. The Saving Mothers and Saving Babies Reports identified patient-related factors as possible causes. Among the patient-related factors was non-attendance; or attendance late in pregnancy; for antenatal care in public hospitals. It would appear that pregnant women confirm their pregnancies by visiting general practitioners; but do not attend antenatal care in the public sector. The aim of this study was to determine healthcare attendance patterns among pregnant women in Durban; South Africa.Methods This was a descriptive study. Participants were recruited and categorised into ""early booker""; ""late booker"" and ""unbooked in labour"" groups. All the participants were interviewed individually using a structured questionnaire. Results: The majority of participants presented for formal ""booking"" late in pregnancy; 47.9""booked"" at a gestationalage of six months after the last menstrual period. Among the ""early bookers""; the majority (94.4) had confirmed their pregnancy by four months of amenorrhoea; and 60.6of these confirmed their pregnancies within the public health sector. All the ""early bookers"" began antenatal care prior to the 20th week of gestation.A total of 66.9of the ""late bookers"" and 66.7of the ""unbooked"" women also had their pregnancies confirmed at four months amenorrhoea; but 49.0of the ""late bookers"" and 59.8of the ""unbooked"" women confirmed their pregnancies in the private health sector. The ""late bookers"" also showed a delay of two to three months between confirming the pregnancy and booking visits. Of the women in this study; 49visited a general practitioner (GP) to confirm the pregnancy after two to four months of amenorrhoea. This figure rose to 53.0if only the ""late bookers"" and the ""unbooked"" were analysed. Further; 35.3visited a GP more than once; either for antenatal care or because of ill health. ConclusionIt is imperative for GPs to understand the role of antenatal care and to refer pregnant women appropriately."

Health Care Attendance Patterns by Pregnant Women In Durban; South Africa

"Background: High rates of perinatal mortality and morbidity and maternal mortality in South Africa remain a major problem. The Saving Mothers and Saving Babies Reports identified patient-related factors as possible causes. Among the patient-related factors was non-attendance; or attendance late in pregnancy; for antenatal care in public hospitals. It would appear that pregnant women confirm their pregnancies by visiting general practitioners; but do not attend antenatal care in the public sector.Aim: The aim of this study was to determine healthcare attendance patterns among pregnant women in Durban; South Africa.Method: This was a descriptive study. Participants were recruited and categorised into ""early booker""; ""late booker"" and ""unbooked in labour"" groups. All the participants were interviewed individually using a structured questionnaire.Results: The majority of participants presented for formal ""booking"" late in pregnancy; 47.9 ""booked"" at a gestational age of six months after the last menstrual period. Among the ""early bookers""; the majority (94.4) had confirmed their pregnancy by four months of amenorrhoea; and 60.6 of these confirmed their pregnancies within the public health sector. All the ""early bookers"" began antenatal care prior to the 20th week of gestation. A total of 66.9 of the ""late bookers"" and 66.7 of the ""unbooked"" women also had their pregnancies confirmed at four months amenorrhoea; but 49.0 of the ""late bookers"" and 59.8of the ""unbooked"" women confirmed their pregnancies in the private health sector. The ""late bookers"" also showed a delay of two to three months between confirming the pregnancy and booking visits. Of the women in this study; 49 visited a general practitioner (GP) to confirm the pregnancy after two to four months of amenorrhoea. This figure rose to 53.0 if only the ""late bookers"" and the ""unbooked"" were analysed. Further; 35.3 visited a GP more than once; either for antenatal care or because of ill health.Conclusion: It is imperative for GPs to understand the role of antenatal care and to refer pregnant women appropriately."