Browsing by Author "van Loggerenberg, Francois."

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Anaemia in acute HIV-1 Subtype C infection.
(Plos., 2007) Mlisana, Koleka Patience.; Auld, Sara C.; Grobler, Anna Christina.; van Loggerenberg, Francois.; Williamson, Carolyn.; Iriogbe, Itua.; Sobieszczyk, Magdalena E.; Abdool Karim, Salim Safurdeen.
Background: The high prevalence of anaemia and the increased morbidity and mortality associated with anaemia during AIDS has been well described yet there has been little information about anaemia and changes in haemoglobin levels during acute and early HIV-1 infection. Methods: HIV-negative women (n = 245) were enrolled into an observational cohort as part of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) Acute Infection Study. Acute infection was diagnosed following a positive HIV RNA PCR in the absence of antibodies, or detection of HIV-1 antibodies within 3 months of a previously negative antibody test. Haemotologic parameters were assessed before infection and at regular intervals in the first twelve months of HIV infection. Results: Fifty-seven participants with acute HIV infection were identified at a median of 14.5 days post-infection (range 10– 81) and were enrolled in the CAPRISA Acute Infection cohort at a median of 41 days post-infection (range 15–104). Mean haemoglobin prior to HIV-1 infection was 12.7 g/dL, with a mean decline of 0.46 g/dL following infection. The prevalence of anaemia increased from 25.0% prior to HIV-1 infection to 52.6% at 3 months post-infection, 61.1% at 6 months postinfection, and 51.4% at 12 months post-infection. Conclusions: Haematologic derangements and anaemia with a trend towards iron deficiency are common with acute HIV-1 subtype C infection in this small cohort. The negative impact of anaemia concurrent with established HIV infection upon morbidity and mortality has been well documented but the prognostic potential and long-term effects of anaemia during acute HIV-1 infection remain unknown.
Assessing adherence in the CAPRISA 004 tenofovir gel HIV prevention trial: results of a nested case–control study.
(Springer., 2014) MacQueen, Kathleen M.; Weaver, Mark A.; van Loggerenberg, Francois.; Succop, Stacey M.; Majola, Nelisile.; Taylor, Douglas.; Abdool Karim, Quarraisha.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing.
(Plos., 2012) Mlisana, Koleka Patience.; Sobieszczyk, Magdalena E.; Werner, Lise.; Feinstein, Addi.; van Loggerenberg, Francois.; Naicker, Nivashnee.; Williamson, Carolyn.; Garrett, Nigel Joel.
Background. Prompt diagnosis of acute HIV infection (AHI) benefits the individual and provides opportunities for public health intervention. The aim of this study was to describe most common signs and symptoms of AHI, correlate these with early disease progression and develop a clinical algorithm to identify acute HIV cases in resource limited setting. Methods. 245 South African women at high-risk of HIV-1 were assessed for AHI and received monthly HIV-1 antibody and RNA testing. Signs and symptoms at first HIV-positive visit were compared to HIV-negative visits. Logistic regression identified clinical predictors of AHI. A model-based score was assigned to each predictor to create a risk score for every woman. Results. Twenty-eight women seroconverted after a total of 390 person-years of follow-up with an HIV incidence of 7.2/100 person-years (95%CI 4.5–9.8). Fifty-seven percent reported ≥1 sign or symptom at the AHI visit. Factors predictive of AHI included age <25 years (OR = 3.2; 1.4–7.1), rash (OR = 6.1; 2.4–15.4), sore throat (OR = 2.7; 1.0–7.6), weight loss (OR = 4.4; 1.5–13.4), genital ulcers (OR = 8.0; 1.6–39.5) and vaginal discharge (OR = 5.4; 1.6–18.4). A risk score of 2 correctly predicted AHI in 50.0% of cases. The number of signs and symptoms correlated with higher HIV-1 RNA at diagnosis (r = 0.63; p<0.001). Conclusions. Accurate recognition of signs and symptoms of AHI is critical for early diagnosis of HIV infection. Our algorithm may assist in risk-stratifying individuals for AHI, especially in resource-limited settings where there is no routine testing for AHI. Independent validation of the algorithm on another cohort is needed to assess its utility further. Point-of-care antigen or viral load technology is required, however, to detect asymptomatic, antibody negative cases enabling early interventions and prevention of transmission.
Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 Acute Infection Study.
(Plos., 2007) van Loggerenberg, Francois.; Mlisana, Koleka Patience.; Williamson, Carolyn.; Auld, Sara C.; Morris, Lynn.; Gray, Clive M.; Abdool Karim, Quarraisha.; Grobler, Anna Christina.; Barnabas, Nomampondo.; Iriogbe, Itua.; Abdool Karim, Salim Safurdeen.
Objectives: To describe the baseline demographic data, clinical characteristics and HIV-incidence rates of a cohort at high risk for HIV infection in South Africa as well as the challenges experienced in establishing and maintaining the cohort. Methodology/Principle Findings: Between August 2004 and May 2005 a cohort of HIV-uninfected women was established for the CAPRISA 002 Acute Infection Study, a natural history study of HIV-1 subtype C infection. Volunteers were identified through peer-outreach. The cohort was followed monthly to determine HIV infection rates and clinical presentation of early HIV infection. Risk reduction counselling and male and female condoms were provided. After screening 775 individuals, a cohort of 245 uninfected high-risk women was established. HIV-prevalence at screening was 59.6% (95% CI: 55.9% to 62.8%) posing a challenge in accruing HIV-uninfected women. The majority of women (78.8%) were self-identified as sex-workers with a median of 2 clients per day. Most women (95%) reported more than one casual sexual partner in the previous 3 months (excluding clients) and 58.8% reported condom use in their last sexual encounter. Based on laboratory testing, 62.0% had a sexually transmitted infection at baseline. During 390 person-years of follow-up, 28 infections occurred yielding seroincidence rate of 7.2 (95% CI: 4.5 to 9.8) per 100 person-years. Despite the high mobility of this sex worker cohort retention rate after 2 years was 86.1%. High co-morbidity created challenges for ancillary care provision, both in terms of human and financial resources. Conclusions/Significance: Challenges experienced were high baseline HIV-prevalence, lower than anticipated HIV-incidence and difficulties retaining participants. Despite challenges, we have successfully accrued this cohort of HIV-uninfected women with favourable retention, enabling us to study the natural history of HIV-1 during acute HIV-infection. Our experiences provide lessons for others establishing similar cohorts, which will be key for advancing the vaccine and prevention research agenda in resource-constrained settings.
Fluidity of HIV-1-Specific T-Cell Responses during Acute and Early Subtype C HIV-1 Infection and Associations with Early Disease Progression.
(American Society for Microbiology, 2010) Mlotshwa, Mandla.; Riou, Catherine.; Chopera, Denis Rutendo.; de Assis Rosa, Debra.; Ntale, Roman.; Treurnicht, Florette K.; Woodman, Zenda.; Werner, Lise.; van Loggerenberg, Francois.; Mlisana, Koleka Patience.; Williamson, Carolyn.; Gray, Clive M.; Abdool Karim, Salim Safurdeen.
Deciphering immune events during early stages of human immunodeficiency virus type 1 (HIV-1) infection is critical for understanding the course of disease. We characterized the hierarchy of HIV-1-specific T-cell gamma interferon (IFN-y) enzyme-linked immunospot (ELISPOT) assay responses during acute subtype C infection in 53 individuals and associated temporal patterns of responses with disease progression in the first 12 months. There was a diverse pattern of T-cell recognition across the proteome, with the recognition of Nef being immunodominant as early as 3 weeks postinfection. Over the first 6 months, we found that there was a 23% chance of an increased response to Nef for every week postinfection (P = 0.0024), followed by a nonsignificant increase to Pol (4.6%) and Gag (3.2%). Responses to Env and regulatory proteins appeared to remain stable. Three temporal patterns of HIV-specific T-cell responses could be distinguished: persistent, lost, or new. The proportion of persistent T-cell responses was significantly lower (P = 0.0037) in individuals defined as rapid progressors than in those progressing slowly and who controlled viremia. Almost 90% of lost T-cell responses were coincidental with autologous viral epitope escape. Regression analysis between the time to fixed viral escape and lost T-cell responses (r = 0.61; P = 0.019) showed a mean delay of 14 weeks after viral escape. Collectively, T-cell epitope recognition is not a static event, and temporal patterns of IFN-y-based responses exist. This is due partly to viral sequence variation but also to the recognition of invariant viral epitopes that leads to waves of persistent T-cell immunity, which appears to associate with slower disease progression in the first year of infection.
Health-related quality of life dynamics of HIV-positive South African women up to ART initiation : evidence from the CAPRISA 002 acute infection cohort study.
(Springer., 2014) Tomita, Andrew.; Garrett, Nigel Joel.; Werner, Lise.; Burns, Jonathan Kenneth.; Mpanza, Lindiwe.; Mlisana, Koleka Patience.; van Loggerenberg, Francois.; Abdool Karim, Salim Safurdeen.
Few studies have investigated the long-term dynamics in health-related quality of life (HRQoL) among HIV-positive persons from acute infection. From 2004, 160 women were enrolled into the CAPRISA 002 Acute Infection study at two sites in the province of KwaZulu-Natal and underwent 3–6 monthly HRQoL assessments using the functional assessment of HIV infection (FAHI) instrument. Overall and 5 sub-scale FAHI scores [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were calculated up to antiretroviral therapy (ART) initiation and scores at enrollment were compared to the acute, early and established infection phases. Mixed-effects regression models adjusting for behavioral and clinical factors were applied to assess HRQoL trends and the proportion of women meeting minimally important differences was calculated. Our analyses revealed that overall/sub-scale scores improved over time, except from PWB and CF. A higher educational status, contraceptive use and a higher BMI were the strongest predictors of higher overall/sub-scale FAHI scores. CD4 count and HIV viral load were strongly associated with PWB and CF, but not overall FAHI and other sub-scales. Women newly diagnosed with acute HIV infection face profound HRQoL challenges. While early ART delivery may be important for PWB and CF, factors such as education, contraception provision and good nutritional status should be promoted to maximize HRQoL in HIV positive individuals.
HIV prevention in high-risk women in South Africa: condom use and the need for change.
(Plos., 2011) van Loggerenberg, Francois.; Dieter, Alexis A.; Sobieszczyk, Magdalena E.; Werner, Lise.; Grobler, Anna Christina.; Mlisana, Koleka Patience.
Introduction: Young women are at disproportionate risk of HIV infection in South Africa. Understanding risk behaviors and factors associated with ability to negotiate safe sex and condom use is likely to be key in curbing the spread of HIV. Traditionally prevention efforts have focused on creating behavioral changes by increasing knowledge about HIV/AIDS. Methods: This was a cross-sectional analysis from a prospective observational cohort study of 245 women at a high-risk of HIV infection in KwaZulu-Natal, South Africa. Results: Participants demonstrated a high level of HIV/AIDS knowledge. Overall, 60.3% of participants reported condom use. Reported condom use at last sexual encounter varied slightly by partner type (57.0% with steady versus 64.4% with casual partners), and self-perceived ability to choose to use a condom was significantly lower with steady partners compared to casual partners (p<0.01). In multivariate analysis, women who had high school education were more likely to use condoms at their last sex encounter compared to those with only primary school education (RR of 1.36 (95% Confidence Interval (CI) 1.06–1.75) and 1.46 (95% CI 1.13–1.88) for grades 8–10 and 11–12, respectively). Those who used condoms as a contraceptive method were twice as likely to use condoms compared to women who did not report using them as a contraceptive method. Greater perceived ability to choose to use condoms was associated with higher self-reported condom use at last encounter, irrespective of partner type (RR = 2.65 (95% CI 2.15–32.5). Discussion: Self-perceived ability to use condoms, level of formal education and condom use as a contraceptive were all significantly associated with self-reported condom use at last sexual encounter. These findings suggest that that gender inequality and access to formal education, as opposed to lack of HIV/AIDS knowledge, prevent safer sexual practices in South Africa.
HIV transmission risk behavior among HIV-positive patients receiving antiretroviral therapy in KwaZulu-Natal, South Africa.
(Springer Science., 2014) Shuper, Paul A.; Kiene, Susan M.; Mahlase, Gethwana.; MacDonald, Susan.; Christie, Sarah.; Cornman, Deborah H.; Fisher, William A.; Greener, Ross.; Lalloo, Umesh Gangaram.; Pillay, Sandy.; van Loggerenberg, Francois.; Fisher, Jeffrey D.
The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV? patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62% of HIV-positive patients’ recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans.
Human immunodeficiency virus-specific gamma interferon enzyme-linked immunospot assay responses targeting specific regions of the proteome during primary subtype C infection are poor predictors of the course of viremia and set point.
(American Society for Microbiology., 2008) Gray, Clive M.; Mlotshwa, Mandla.; Riou, Catherine.; Mathebula, Tiyani.; Mashishi, Tumelo.; Seoighe, Cathal.; Ngandu, Nobubelo K.; de Assis Rosa, Debra.; van Loggerenberg, Francois.; Morris, Lynn.; Mlisana, Koleka Patience.; Williamson, Carolyn.; Abdool Karim, Salim Safurdeen.
It is unknown whether patterns of human immunodeficiency virus (HIV)-specific T-cell responses during acute infection may influence the viral set point and the course of disease. We wished to establish whether the magnitude and breadth of HIV type 1 (HIV-1)-specific T-cell responses at 3 months postinfection were correlated with the viral-load set point at 12 months and hypothesized that the magnitude and breadth of HIV-specific T-cell responses during primary infection would predict the set point. Gamma interferon (IFN-γ) enzyme-linked immunospot (ELISPOT) assay responses across the complete proteome were measured in 47 subtype C HIV-1-infected participants at a median of 12 weeks postinfection. When corrected for amino acid length and individuals responding to each region, the order of recognition was as follows: Nef > Gag > Pol > Rev > Vpr > Env > Vpu > Vif > Tat. Nef responses were significantly (P < 0.05) dominant, targeted six epitopic regions, and were unrelated to the course of viremia. There was no significant difference in the magnitude and breadth of responses for each protein region with disease progression, although there was a trend of increased breadth (mean, four to seven pools) in rapid progressors. Correlation of the magnitude and breadth of IFN-γ responses with the viral set point at 12 months revealed almost zero association for each protein region. Taken together, these data demonstrate that the magnitude and breadth of IFN-γ ELISPOT assay responses at 3 months postinfection are unrelated to the course of disease in the first year of infection and are not associated with, and have low predictive power for, the viral set point at 12 months.
Impact of antiretroviral therapy on health-related quality of life among South African women in the CAPRISA 002 acute infection study.
(Springer., 2014) Tomita, Andrew.; Garrett, Nigel Joel.; Werner, Lise.; Burns, Jonathan Kenneth.; Ngcobo, Nelisiwe.; Zuma, Nomthandazo.; Mlisana, Koleka Patience.; van Loggerenberg, Francois.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: Findings of the CAPRISA 058 randomised controlled trial.
(Springer., 2015) van Loggerenberg, Francois.; Grant, Alison D.; Naidoo, Kogieleum.; Murrman, Marita.; Gengiah, Santhanalakshmi.; Gengiah, Tanuja Narayansamy.; Fielding, Katherine L.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Plasma cytokine levels during acute HIV-1 infection predict HIV disease progression.
(Lippincott Williams & Wilkins., 2010) Roberts, Lindi.; Williamson, Carolyn.; Little, Francesca.; Bebell, Lisa M.; Mlisana, Koleka Patience.; Burgers, Wendy A.; Passmore, Jo-Ann Shelley.; van Loggerenberg, Francois.; Walzl, Gerhard.; Djoba Siawaya, Joel Fleury.; Abdool Karim, Salim Safurdeen.; Abdool Karim, Quarraisha.
Background: Both T-cell activation during early HIV-1 infection and soluble markers of immune activation during chronic infection are predictive of HIV disease progression. Although the acute phase of HIV infection is associated with increased pro-inflammatory cytokine production, the relationship between cytokine concentrations and HIV pathogenesis is unknown. Objectives: To identify cytokine biomarkers measurable in plasma during acute HIV-1 infection that predict HIV disease progression. Design: Study including 40 South African women who became infected with HIV-1 and were followed longitudinally from the time of infection. Methods: The concentrations of 30 cytokines in plasma from women with acute HIV-1 infection were measured and associations between cytokine levels and both viral load set point 12 months postinfection and time taken for CD4 cell counts to fall below 350 cells/ul were determined using multivariate and Cox proportional hazards regression. Results: We found that the concentrations of five plasma cytokines, IL-12p40, IL-12p70, IFN-y, IL-7 and IL-15 in women with acute infection predicted 66% of the variation in viral load set point 12 months postinfection. IL-12p40, IL-12p70 and IFN-y were significantly associated with lower viral load, whereas IL-7 and IL-15 were associated with higher viral load. Plasma concentrations of IL-12p40 and granulocyte–macrophage colony-stimulating factor during acute infection were associated with maintenance of CD4 cell counts above 350 cells/ul, whereas IL-1a, eotaxin and IL-7 were associated with more rapid CD4 loss. Conclusion: A small panel of plasma cytokines during acute HIV-1 infection was predictive of long-term HIV disease prognosis in this group of South African women.
A qualitative study of patient motivation to adhere to combination antiretroviral therapy in South Africa.
(Mary Ann Liebert., 2015) van Loggerenberg, Francois.; Gray, Debra.; Gengiah, Santhanalakshmi.; Kunene, Pinky.; Gengiah, Tanuja Narayansamy.; Naidoo, Kogieleum.; Grant, Alison D.
Abstract available in pdf.
Rapid disease progression in HIV-1 subtype C–infected South African women.
(Oxford University Press., 2014) Mlisana, Koleka Patience.; Werner, Lise.; Garrett, Nigel Joel.; McKinnon, Lyle R.; van Loggerenberg, Francois.; Passmore, Jo-Ann Shelley.; Gray, Clive M.; Morris, Lynn.; Williamson, Carolyn.; Abdool Karim, Salim Safurdeen.
Background. Whereas human immunodeficiency virus (HIV) subtype B–infected individuals generally progress to AIDS within 8–10 years, limited data exist for other clades, especially from Africa. We investigated rates of HIV disease progression of clade C–infected South African women. Methods. Prospective seroincidence cohorts in KwaZulu-Natal were assessed for acute HIV infection monthly (n = 245) or every 3 months (n = 594) for up to 4 years. Rapid disease progression was defined as CD4 decline to <350 cells/μL by 2 years postinfection. Serial clinical and laboratory assessments were compared using survival analysis and logistic regression models. Results. Sixty-two women were identified at a median of 42 days postinfection (interquartile range, 34–59), contributing 282 person-years of follow-up. Mean CD4 count dropped by 39.6% at 3 months and 46.7% at 6 months postinfection in women with preinfection measurements. CD4 decline to <350 cells/μL occurred in 31%, 44%, and 55% of women at 1, 2, and 3 years postinfection, respectively, and to <500 cells/μL in 69%, 79%, and 81% at equivalent timepoints. Predictors of rapid progression were CD4 count at 3 months postinfection (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.31–3.28; P = .002), setpoint viral load (HR, 3.82; 95% CI, 1.51–9.67; P = .005), and hepatitis B coinfection (HR, 4.54; 95% CI, 1.31–15.69; P = .017). Conversely, presence of any of HLAB*1302, B*27, B*57, B*5801, or B*8101 alleles predicted non–rapid progression (HR, 0.19; 95% CI, .05–.74; P = .016). Conclusions. Nearly half of subtype C–infected women progressed to a CD4 count <350 cells/μL within 2 years of infection. Implementing 2013World Health Organization treatment guidelines (CD4 count <500 cells/μL) would require most individuals to start antiretroviral therapy within 1 year of HIV infection.
Relationship between levels of inflammatory cytokines in the genital tract and CD4+ cell counts in women with acute HIV-1 infection.
(The Infectious Diseases Society of America., 2008) Bebell, Lisa M.; Passmore, Jo-Ann Shelley.; Williamson, Carolyn.; Mlisana, Koleka Patience.; Iriogbe, Itua.; van Loggerenberg, Francois.; Abdool Karim, Quarraisha.; Abdool Karim, Salim Safurdeen.
Inflammatory responses at mucosal surfaces after human immunodeficiency virus type 1 (HIV-1) transmission may influence disease outcome.We evaluated levels of interleukin (IL)–1B , IL-6, tumor necrosis factor– a, IL-8, IL-10, and IL-12 in genital tract and plasma specimens from 44 women with acute HIV infection and 29 HIV-negative control women (13 of whom were women in the acute HIV infection cohort who had preinfection samples available for analysis). Women with acute HIV infection had significantly elevated levels of IL-6, IL-10, and IL-12 in genital tract specimens and elevated levels of IL-1B , IL-8, and IL-10 in plasma specimens, compared with HIV-negative control women. Levels of IL-1B , IL-6, and IL-8 in cervicovaginal specimens from women with acute HIV infection showed a significant inverse correlation with systemic CD4 + cell counts, suggesting that mucosal inflammation is associated with low CD4 + cell counts during acute HIV infection.
Risk factors for HIV acquisition in high risk women in a generalised epidemic setting.
(Springer., 2015) Naicker, Nivashnee.; Kharsany, Ayesha Bibi Mahomed.; Werner, Lise.; van Loggerenberg, Francois.; Mlisana, Koleka Patience.; Garrett, Nigel Joel.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Sexually transmitted infection as a risk factor for HIV : describing treatment seeking behaviours and sexual risk practices of clinic attendees at the Cyril Zulu Communicable Diseases Centre : a potential application of the information-motivation-behaviour skills model for HIV prevention interventions.
(2004) van Loggerenberg, Francois.; Solomon, Vernon Philip.
Co-infection with a sexually transmitted infection (STI) is both an indicator of behavioural risk, as well as an indicator of increased risk for infection with HIV. This is a cross-sectional, descriptive study. The overall aim of the study is to profile the demographic data, health seeking behaviour, sexual risk behaviour and HIV awareness and willingness to test in a sample of STI clinic attendees in order to inform intervention programmes aimed at reducing the burden of disease in this group, thereby reducing HIV risk. It is hypothesised that those individuals who are poorly informed about key prevention information (particularly regarding the biological susceptibility to HIV infection when co-infected with an STI), who are poorly motivated due to poor attitudes towards or lack of social norms in favour of prevention behaviour, and who lack some key behaviour skills (like skills for identifying STIs early, or negotiating safer sexual practises) will be less likely to be able to initiate and maintain specific prevention behaviours. Data are collected using a structured questionnaire and analysed in relation to the Information-Motivation Behavioural Skills (IMB) model of HIV prevention behaviour. This model was specifically developed to provide a conceptual framework for the design, implementation and assessment of targeted and empirically focussed interventions to change sexual risk behaviour in HIV. Components of the IMB model that are identified as important in contributing to risk of infection in this group are identified. Finally, recommendations regarding the form and content of an intervention in this group are made. The study concludes that STI clinics may be excellent environments within which to implement HIV risk reduction pehavioural interventions which currently may be missed opportunities.
Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa.
(Oxford University Press., 2011) Mlisana, Koleka Patience.; Naicker, Nivashnee.; Werner, Lise.; Roberts, Lindi.; van Loggerenberg, Francois.; Baxter, Cheryl.; Passmore, Jo-Ann Shelley.; Grobler, Anna Christina.; Sturm, Adriaan Willem.; Williamson, Carolyn.; Ronacher, Katharina.; Walzl, Gerhard.; Abdool Karim, Salim Safurdeen.
Background. Diagnosis and treatment of sexually transmitted infections (STIs) is a public health priority, particularly in regions where the incidence of human immunodeficiency virus (HIV) infection is high. In most developing countries, STIs are managed syndromically. We assessed the adequacy of syndromic diagnosis of STIs, compared with laboratory diagnosis of STIs, and evaluated the association between STI diagnosis and the risk of HIV acquisition in a cohort of high-risk women. Methods. HIV-uninfected high-risk women (n = 242) were followed for 24 months. Symptoms of STIs were recorded, and laboratory diagnosis of common STI pathogens was conducted every 6 months. Forty-two cytokines were measured by Luminex in cervicovaginal lavage specimens at enrollment. Human immunodeficiency virus type 1 (HIV-1) infection was evaluated monthly. Results. Only 12.3% of women (25 of 204) who had a laboratory-diagnosed, discharge-causing STI had clinically evident discharge. Vaginal discharge was thus a poor predictor of laboratory-diagnosed STIs (sensitivity, 12.3%; specificity, 93.8%). Cervicovaginal cytokine concentrations did not differ between women with asymptomatic STIs and those with symptomatic STIs and were elevated in women with asymptomatic STIs, compared with women with no STIs or bacterial vaginosis. Although laboratory-diagnosed STIs were associated with increased risk of HIV infection (hazard ratio, 3.3 [95% confidence interval, 1.5–7.2)], clinical symptoms were not. Conclusions. Syndromic STI diagnosis dependent on vaginal discharge was poorly predictive of laboratory-diagnosed STI. Laboratory-diagnosed STIs were associated with increased susceptibility to HIV acquisition, while vaginal discharge was not.
Trial participation disclosure and gel use behavior in the CAPRISA 004 tenofovir gel trial.
(Succop, S.M., MacQueen, K.M., van Loggerenberg, F., Majola, N., Abdool Karim, Q. and Abdool Karim, S.S. 2014. Trial participation disclosure and gel use behavior in the CAPRISA 004 tenofovir gel trial. AIDS care 26(12), 1521-1525., 2014) Succop, Stacey M.; MacQueen, Kathleen M.; van Loggerenberg, Francois.; Majola, Nelisile.; Abdool Karim, Quarraisha.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.