2008
|
Muwanga, A.; Easterbrook, Philippa; Schaefer, P.; Wandera, M.; abd B. Castelnuovo, D. Okello; Kamya, M.; Kambugu, A. Losses to Follow-up in a Large ART Program in Uganda Proceedings no. 840, 2008. @proceedings{Muwanga2008,
title = {Losses to Follow-up in a Large ART Program in Uganda},
author = {A. Muwanga and Philippa Easterbrook and P. Schaefer and M. Wandera and D. Okello abd B. Castelnuovo and M. Kamya and A. Kambugu},
year = {2008},
date = {2008-02-03},
number = {840},
series = {15th Conference on Retroviruses and Opportunistic Infections 3rd – 6th February 2008, Boston, USA},
abstract = {BACKGROUND: The high reported levels of adherence and viral suppression with ART represent considerable successes of the rollout programs across Sub-Saharan Africa. However, these data are based only on those who remain in care and under follow-up. High rates of loss to follow-up would significantly limit the effectiveness of ART and other preventative strategies. There is an urgent need for information on retention rates in these programs to guide the optimal delivery of care. Our objective was to undertake a systematic survey of reasons for loss to follow-up, particularly among patients receiving ART in a large HIV clinic in Uganda. METHODS: The Infectious Diseases Institute is a regional center of excellence for HIV treatment and care in Uganda. Between April 2004 and October 2007, 19,577 patients registered for care, of whom 13,099 remain in active follow-up. We defined loss to follow-up as non-clinic attendance for =1 year for those not on ART (non-ART), and =3 months for those receiving ART. A telephone survey was undertaken to determine reasons for loss to follow-up among those on ART. RESULTS: Of 19,577 registered patients, 6654 were started on ART 64% were female, 74.7% had WHO stage 3 or 4, and the median CD4 count at ART initiation was 93 cells. Overall, 6449 (32.9%) were lost to follow-up: 831 (17.8%) were on ART, and 4864 (75%) were non-ART patients. Of the 4864 non-ART loss to follow-up, 2041 (42%) had attended for only 1 visit and had no investigations, 1400 (28.8%) had a CD4 count 1000 cells, 68 (1.4%) transferred follow-up to a family clinic, and 318 (6.5%) were followed only as research subjects. Of 831 ART loss to follow-up, 480 (57.8%) had not been seen for >1 year, 208 (25%) for 6 to 12 months, and 143 (17.2%) for 3 to 6 months. Overall, 51.6% could not be contacted because their telephone number was incorrect or not recorded. Of the remainder, 19.1% were confirmed dead, 14.1% had transferred to other sites, and 14.1% gave various reasons, including drug discontinuation (6.1%). CONCLUSIONS: This is the first systematic study of losses to follow-up in a large HIV clinic in Sub-Saharan Africa. The 20% loss to follow-up attributable to death among those on ART, is likely to be an underestimate since half of them could not be contacted. Further tracking of these patients through home-visits is ongoing. Strategies to improve retention include weekly monitoring and tracking of ART patients loss to follow-up for >1 month, as well as regular updating of contact details and formal logging of transfers.},
keywords = {},
pubstate = {published},
tppubtype = {proceedings}
}
BACKGROUND: The high reported levels of adherence and viral suppression with ART represent considerable successes of the rollout programs across Sub-Saharan Africa. However, these data are based only on those who remain in care and under follow-up. High rates of loss to follow-up would significantly limit the effectiveness of ART and other preventative strategies. There is an urgent need for information on retention rates in these programs to guide the optimal delivery of care. Our objective was to undertake a systematic survey of reasons for loss to follow-up, particularly among patients receiving ART in a large HIV clinic in Uganda. METHODS: The Infectious Diseases Institute is a regional center of excellence for HIV treatment and care in Uganda. Between April 2004 and October 2007, 19,577 patients registered for care, of whom 13,099 remain in active follow-up. We defined loss to follow-up as non-clinic attendance for =1 year for those not on ART (non-ART), and =3 months for those receiving ART. A telephone survey was undertaken to determine reasons for loss to follow-up among those on ART. RESULTS: Of 19,577 registered patients, 6654 were started on ART 64% were female, 74.7% had WHO stage 3 or 4, and the median CD4 count at ART initiation was 93 cells. Overall, 6449 (32.9%) were lost to follow-up: 831 (17.8%) were on ART, and 4864 (75%) were non-ART patients. Of the 4864 non-ART loss to follow-up, 2041 (42%) had attended for only 1 visit and had no investigations, 1400 (28.8%) had a CD4 count 1000 cells, 68 (1.4%) transferred follow-up to a family clinic, and 318 (6.5%) were followed only as research subjects. Of 831 ART loss to follow-up, 480 (57.8%) had not been seen for >1 year, 208 (25%) for 6 to 12 months, and 143 (17.2%) for 3 to 6 months. Overall, 51.6% could not be contacted because their telephone number was incorrect or not recorded. Of the remainder, 19.1% were confirmed dead, 14.1% had transferred to other sites, and 14.1% gave various reasons, including drug discontinuation (6.1%). CONCLUSIONS: This is the first systematic study of losses to follow-up in a large HIV clinic in Sub-Saharan Africa. The 20% loss to follow-up attributable to death among those on ART, is likely to be an underestimate since half of them could not be contacted. Further tracking of these patients through home-visits is ongoing. Strategies to improve retention include weekly monitoring and tracking of ART patients loss to follow-up for >1 month, as well as regular updating of contact details and formal logging of transfers. |
Kambugu, A.; Castelnuovo, B.; Kiragga, A.; Kigonya, K; Kamya, M.; Easterbrook, P. Cause-specific Mortality and Contribution of Immune Reconstitution Inflammatory Syndrome during the First 2 Years of ART in Uganda Proceedings no. 845, 2008. @proceedings{Kambugu2008,
title = {Cause-specific Mortality and Contribution of Immune Reconstitution Inflammatory Syndrome during the First 2 Years of ART in Uganda},
author = {A. Kambugu and B. Castelnuovo and A. Kiragga and K Kigonya and M. Kamya and P. Easterbrook },
year = {2008},
date = {2008-02-02},
number = {845},
series = {15th Conference on Retroviruses and Opportunistic Infections 3rd – 6th February 2008, Boston, USA},
abstract = {BACKGROUND: Recent data suggest that immune reconstitution inflammatory syndrome (IRIS) may be a significant cause of death in the first months of ART in low-income countries. We determined cause-specific mortality and contribution of IRIS during the first 24 months of ART in an urban cohort in Uganda. METHODS: A prospective cohort of 559 patients initiated on stavudine (d4T)/zidovudine (AZT), lamivudine (3TC), and nevirapine (NVP)/efavirenz (EFV) between April 2004 and April 2005 at the Infectious Diseases Institute. Patients were reviewed monthly. Cause of death was determined from medical record review and other sources. IRIS was defined as new onset with atypical presentation (unmasking) or worsening of an ongoing opportunistic infection (paradoxical) within 6 months of ART initiation. A multivariate Cox model was used to identify independent risk factors of HIV-related mortality. RESULTS: Of 559 patients, 70% were female. At ART initiation, 88% were World Health Organization (WHO) stage 3-4; median age was 36 years; CD4+ count and viral load were 104 cell/mL and 5.4 logs, respectively; 74% were started on NVP and 36% on EFV-based regimens. Of the total, 22 (3.9%) were lost to follow-up; 80 (14%) died during the first 12 months (incidence was 181/100 person-years of ART), of which 58 (73%) within the first 3 months; 15 died (3%) during the second year (10.9/100 person-years of ART). In the first year, 69 (86%) of the deaths were HIV-related: 24% due to central nervous system (CNS) infections (cryptococcal meningitis, toxoplasmosis, and Herpes zoster); 14.5% to tuberculosis, 10.1% to Kaposis’ sarcoma, and 7.2% to Pneumocystis jirovecii pneumonia; 2 deaths (2.5%) were due to ART mitochondrial toxicity. Of 69 deaths, 5 (7%) were attributed to IRIS, 4 to unmasking IRIS (2 extra pulmonary TB, 1 cryptococcal meningitis, 1 intracerebral mass), and 1 to paradoxical cryptococcal meningitis. In the second year, only 4 of 15 (27%) deaths were HIV related, 8 (53%) due to other medical conditions and 3(20%) to ART mitochondrial toxicity. Risk factors for HIV-related death were WHO stage 3/4 (HR 3.38, CI 1.02 to 11.7) and baseline CD4+ count},
keywords = {},
pubstate = {published},
tppubtype = {proceedings}
}
BACKGROUND: Recent data suggest that immune reconstitution inflammatory syndrome (IRIS) may be a significant cause of death in the first months of ART in low-income countries. We determined cause-specific mortality and contribution of IRIS during the first 24 months of ART in an urban cohort in Uganda. METHODS: A prospective cohort of 559 patients initiated on stavudine (d4T)/zidovudine (AZT), lamivudine (3TC), and nevirapine (NVP)/efavirenz (EFV) between April 2004 and April 2005 at the Infectious Diseases Institute. Patients were reviewed monthly. Cause of death was determined from medical record review and other sources. IRIS was defined as new onset with atypical presentation (unmasking) or worsening of an ongoing opportunistic infection (paradoxical) within 6 months of ART initiation. A multivariate Cox model was used to identify independent risk factors of HIV-related mortality. RESULTS: Of 559 patients, 70% were female. At ART initiation, 88% were World Health Organization (WHO) stage 3-4; median age was 36 years; CD4+ count and viral load were 104 cell/mL and 5.4 logs, respectively; 74% were started on NVP and 36% on EFV-based regimens. Of the total, 22 (3.9%) were lost to follow-up; 80 (14%) died during the first 12 months (incidence was 181/100 person-years of ART), of which 58 (73%) within the first 3 months; 15 died (3%) during the second year (10.9/100 person-years of ART). In the first year, 69 (86%) of the deaths were HIV-related: 24% due to central nervous system (CNS) infections (cryptococcal meningitis, toxoplasmosis, and Herpes zoster); 14.5% to tuberculosis, 10.1% to Kaposis’ sarcoma, and 7.2% to Pneumocystis jirovecii pneumonia; 2 deaths (2.5%) were due to ART mitochondrial toxicity. Of 69 deaths, 5 (7%) were attributed to IRIS, 4 to unmasking IRIS (2 extra pulmonary TB, 1 cryptococcal meningitis, 1 intracerebral mass), and 1 to paradoxical cryptococcal meningitis. In the second year, only 4 of 15 (27%) deaths were HIV related, 8 (53%) due to other medical conditions and 3(20%) to ART mitochondrial toxicity. Risk factors for HIV-related death were WHO stage 3/4 (HR 3.38, CI 1.02 to 11.7) and baseline CD4+ count |
Castelnuovo, B.; John, L.; Lutwama, F.; Ronald, A.; Spacek, LA.; Bates, M.; Kamya, MR.; Colebunders, R. Three-year outcome data of second-line antiretroviral therapy in Ugandan adults: good virological response but high rate of toxicity. Journal Article In: vol. 8, no. 1, pp. 52-9, 2008. @article{Castelnuovo2008d,
title = {Three-year outcome data of second-line antiretroviral therapy in Ugandan adults: good virological response but high rate of toxicity.},
author = {B. Castelnuovo and L. John and F. Lutwama and A. Ronald and LA. Spacek and M. Bates and MR. Kamya and R. Colebunders },
doi = {10.1177/1545109708328538},
year = {2008},
date = {2008-01-30},
volume = {8},
number = {1},
pages = {52-9},
abstract = {OBJECTIVE:
To evaluate the safety and virological response to lopinavir/ritonavir containing second-line therapy after failing a first line nonnucleoside reverse transcriptase inhibitor (NNRTI) based regimen.
DESIGN:
Prospective 36 months cohort study of patients switched to zidovudine/stavudine plus didanosine plus lopinavir/ritonavir capsules as second-line regimen.
METHODOLOGY:
Structured interview, medical examination, and laboratory assessment performed every 6 months.
RESULTS:
We enrolled 40 patients; 1 died and 3 were lost to follow-up. Median CD4+ count at baseline was 108 cell/microL, median log viral load was 4.8 copies/mL. Sixteen (40%) patients had baseline genotypic resistant test, 14 (87%) had lamivudine resistance mutations, and all had NNRTIs resistance mutations. At month 36, 82% of the patients achieved viral suppression (<400 copies/ mL) and the median increase in CD4+ count was 214 cell/microL, (interquartile range: 128-295). Twenty-five patients (62%) experienced at least one adverse event.
CONCLUSIONS:
Our study confirms lopinavir/ ritonavir-based second-line regimen but with a high rate of toxicities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE:
To evaluate the safety and virological response to lopinavir/ritonavir containing second-line therapy after failing a first line nonnucleoside reverse transcriptase inhibitor (NNRTI) based regimen.
DESIGN:
Prospective 36 months cohort study of patients switched to zidovudine/stavudine plus didanosine plus lopinavir/ritonavir capsules as second-line regimen.
METHODOLOGY:
Structured interview, medical examination, and laboratory assessment performed every 6 months.
RESULTS:
We enrolled 40 patients; 1 died and 3 were lost to follow-up. Median CD4+ count at baseline was 108 cell/microL, median log viral load was 4.8 copies/mL. Sixteen (40%) patients had baseline genotypic resistant test, 14 (87%) had lamivudine resistance mutations, and all had NNRTIs resistance mutations. At month 36, 82% of the patients achieved viral suppression (<400 copies/ mL) and the median increase in CD4+ count was 214 cell/microL, (interquartile range: 128-295). Twenty-five patients (62%) experienced at least one adverse event.
CONCLUSIONS:
Our study confirms lopinavir/ ritonavir-based second-line regimen but with a high rate of toxicities. |
Moore, CC.; Jacob, ST.; Pinkerton, R.; Meya, DB.; Mayanja-Kizza, H.; Reynolds, SJ.; Scheld, WM. Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda Journal Article In: Clinical Infectious Diseases, vol. 46, no. 2, pp. 215-22, 2008. @article{Moore2008,
title = {Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda},
author = {CC. Moore and ST. Jacob and R. Pinkerton and DB. Meya and H. Mayanja-Kizza and SJ. Reynolds and WM. Scheld},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/The-Cost-Effectiveness-of-a-Pharmacy-Only-Refill-Program-in-a-Large-Urban-HIV-AIDS-Clinic-in-Kampala-Uganda-1.pdf},
doi = {10.1086/524665},
year = {2008},
date = {2008-01-15},
journal = {Clinical Infectious Diseases},
volume = {46},
number = {2},
pages = {215-22},
abstract = {BACKGROUND: Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL) analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis. METHODS: A prospective observational study enrolled 253 patients at a national referral hospital in Uganda. Inclusion criteria required (1) >or=2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate measured. The primary measured outcome was in-hospital mortality. RESULTS: Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type 1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6% (30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P=.001). The receiver operating characteristic area under the curve for PWBL was 0.81 (P=.081). The optimal PWBL concentration for predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was >or=4.0 mmol/L. Patients with a PWBL concentration >or=4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration or=4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of patients with sepsis than does a PWBL concentration re and poor reliability.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL) analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis. METHODS: A prospective observational study enrolled 253 patients at a national referral hospital in Uganda. Inclusion criteria required (1) >or=2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate measured. The primary measured outcome was in-hospital mortality. RESULTS: Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type 1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6% (30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P=.001). The receiver operating characteristic area under the curve for PWBL was 0.81 (P=.081). The optimal PWBL concentration for predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was >or=4.0 mmol/L. Patients with a PWBL concentration >or=4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration or=4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of patients with sepsis than does a PWBL concentration re and poor reliability. |
Castelnuovo, Barbara; Ocama, Ponsiano; Songa, Patricia Mwebaze; Kambugu, Andrew Reply to van Griensven et al. Journal Article In: Clinical Infectious Diseases, vol. 46, no. 2, pp. 322, 2008. @article{Castelnuovo2008b,
title = {Reply to van Griensven et al. },
author = {Barbara Castelnuovo and Ponsiano Ocama and Patricia Mwebaze Songa and Andrew Kambugu },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Reply-to-Van-Griensven-et-al..pdf},
doi = {https://doi.org/10.1086/524224},
year = {2008},
date = {2008-01-15},
journal = {Clinical Infectious Diseases},
volume = {46},
number = {2},
pages = {322},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Castelnuovo, B.; Byakwaga, H.; Menten, J.; Schaefer, P.; Kamya, M.; Colebunders, R. Can response of a pruritic papular eruption to antiretroviral therapy be used as a clinical parameter to monitor virological outcome? Journal Article In: AIDS, vol. 22, no. 2, pp. 269-73, 2008. @article{Castelnuovo2008,
title = {Can response of a pruritic papular eruption to antiretroviral therapy be used as a clinical parameter to monitor virological outcome?},
author = {B. Castelnuovo and H. Byakwaga and J. Menten and P. Schaefer and M. Kamya and R. Colebunders},
doi = {10.1097/QAD.0b013e3282f313a9},
year = {2008},
date = {2008-01-11},
journal = {AIDS},
volume = {22},
number = {2},
pages = {269-73},
abstract = {BACKGROUND:
A pruritic papular eruption (PPE) is a common skin manifestation observed in 12-46% of persons with HIV infection living in tropical countries.
OBJECTIVE:
To determine whether PPE responds to HAART and whether monitoring PPE severity could be used as a clinical marker to predict virological outcome in resource-limited settings where viral load testing is not available.
METHODS:
The study enrolled 53 patients with PPE for at least 1 month before starting a first-line HAART regimen as part of a prospective study. CD4 cell count and viral load were measured at enrolment and every 3 months. A scoring system was developed to evaluate the PPE severity by asking two questions. Over the last month how itchy has your skin been? Over the last month how has itching interfered with your sleep?
RESULTS:
Median CD4 cell count was 15 cells/mul and median viral load 268 663 copies/ml. All patients initiated a regimen containing a nonnucleoside reverse transcriptase inhibitor. Mean PPE score declined from 3.9 at enrolment to 0.1 at 24 months. In 37 (86%) of the 43 patients with at least 6 months of follow-up data, the PPE disappeared and never returned. Patients with viral load > 400 copies/ml at months 9 and/or 12 had significantly higher PPE scores at months 9 to 12 than the patients with < 400 copies/ml.
CONCLUSIONS:
In most patients, PPE disappears during HAART and PPE severity scores were higher in patients whose first-line HAART failed to control plasma viral load.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
A pruritic papular eruption (PPE) is a common skin manifestation observed in 12-46% of persons with HIV infection living in tropical countries.
OBJECTIVE:
To determine whether PPE responds to HAART and whether monitoring PPE severity could be used as a clinical marker to predict virological outcome in resource-limited settings where viral load testing is not available.
METHODS:
The study enrolled 53 patients with PPE for at least 1 month before starting a first-line HAART regimen as part of a prospective study. CD4 cell count and viral load were measured at enrolment and every 3 months. A scoring system was developed to evaluate the PPE severity by asking two questions. Over the last month how itchy has your skin been? Over the last month how has itching interfered with your sleep?
RESULTS:
Median CD4 cell count was 15 cells/mul and median viral load 268 663 copies/ml. All patients initiated a regimen containing a nonnucleoside reverse transcriptase inhibitor. Mean PPE score declined from 3.9 at enrolment to 0.1 at 24 months. In 37 (86%) of the 43 patients with at least 6 months of follow-up data, the PPE disappeared and never returned. Patients with viral load > 400 copies/ml at months 9 and/or 12 had significantly higher PPE scores at months 9 to 12 than the patients with < 400 copies/ml.
CONCLUSIONS:
In most patients, PPE disappears during HAART and PPE severity scores were higher in patients whose first-line HAART failed to control plasma viral load. |
Kigonya, C.; Lutwama, F.; Colebunders, F. Extensive hypopigmentation after starting antiretroviral treatment in an human immunodeficiency virus (HIV)-seropositive African woman Journal Article In: International Journal of Dermatology, vol. 47, no. 1, pp. 102-3, 2008. @article{Kigonya2008,
title = {Extensive hypopigmentation after starting antiretroviral treatment in an human immunodeficiency virus (HIV)-seropositive African woman},
author = {C. Kigonya and F. Lutwama and F. Colebunders },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Extensive-hypopigmentation-after-starting-antiretroviral-treatment-in-an-human-immunodeficiency-virus-HIV-seropositive-African-womantology.pdf},
doi = {10.1111/j.1365-4632.2007.03353.x.},
year = {2008},
date = {2008-01-01},
journal = { International Journal of Dermatology},
volume = {47},
number = {1},
pages = {102-3},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
2007
|
Trachtenberg, JD.; Kambugu, AD.; M, McKellar; Mayanja-Kizza, F. Semitala H.; Samore, MH.; Ronald, A.; Sande, MA. The medical management of central nervous system infections in Uganda and the potential impact of an algorithm-based approach to improve outcomes. Journal Article In: International Journal of Infectious Diseases, vol. 11, no. 6, pp. 524-30, 2007. @article{Trachtenberg2007,
title = {The medical management of central nervous system infections in Uganda and the potential impact of an algorithm-based approach to improve outcomes.},
author = {JD. Trachtenberg and AD. Kambugu and M, McKellar and F. Semitala H. Mayanja-Kizza and MH. Samore and A. Ronald and MA. Sande },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/The-medical-management-of-central-nervous-system-infections-in-Uganda-and-the-potential-impact-of-an-algorithm-based-approach-to-improve-outcomes..pdf},
doi = {https://doi.org/10.1016/j.ijid.2007.01.014},
year = {2007},
date = {2007-11-01},
journal = {International Journal of Infectious Diseases},
volume = {11},
number = {6},
pages = {524-30},
abstract = {BACKGROUND:
In sub-Saharan Africa, HIV has increased the spectrum of central nervous system (CNS) infections. The etiological diagnosis is often difficult. Mortality from CNS infections is higher in sub-Saharan Africa compared to Western countries. This study examines the medical management of CNS infections in Uganda. We also propose a clinical algorithm to manage CNS infections in an effective, systematic, and resource-efficient manner.
METHODS:
We prospectively followed 100 consecutive adult patients who were admitted to Mulago Hospital with a suspected diagnosis of a CNS infection without any active participation in their management. From the clinical and outcome data, we created an algorithm to manage CNS infections, which was appropriate for this resource-limited, high HIV prevalence setting.
RESULTS:
Only 32 patients had a laboratory confirmed diagnosis and 23 of these were diagnosed with cryptococcal meningitis. Overall mortality was 39%, and mortality trended upward when the diagnosis was delayed past 3 days. The initial diagnoses were made clinically without significant laboratory data in 92 of the 100 patients. Because HIV positive patients have a unique spectrum of CNS infections, we created an algorithm that identified HIV-positive patients and diagnosed those with cryptococcal meningitis. After cryptococcal infection was ruled out, previously published algorithms were used to assist in the early diagnosis and treatment of bacterial meningitis, tuberculous meningitis, and other common central nervous system infections. In retrospective comparison with current management, the CNS algorithm reduced overall time to diagnosis and initiate treatment of cryptococcal meningitis from 3.5 days to less than 1 day.
CONCLUSIONS:
CNS infections are complex and difficult to diagnose and treat in Uganda, and are associated with high in-hospital mortality. A clinical algorithm may significantly decrease the time to diagnose and treat CNS infections in a resource-limited setting.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
In sub-Saharan Africa, HIV has increased the spectrum of central nervous system (CNS) infections. The etiological diagnosis is often difficult. Mortality from CNS infections is higher in sub-Saharan Africa compared to Western countries. This study examines the medical management of CNS infections in Uganda. We also propose a clinical algorithm to manage CNS infections in an effective, systematic, and resource-efficient manner.
METHODS:
We prospectively followed 100 consecutive adult patients who were admitted to Mulago Hospital with a suspected diagnosis of a CNS infection without any active participation in their management. From the clinical and outcome data, we created an algorithm to manage CNS infections, which was appropriate for this resource-limited, high HIV prevalence setting.
RESULTS:
Only 32 patients had a laboratory confirmed diagnosis and 23 of these were diagnosed with cryptococcal meningitis. Overall mortality was 39%, and mortality trended upward when the diagnosis was delayed past 3 days. The initial diagnoses were made clinically without significant laboratory data in 92 of the 100 patients. Because HIV positive patients have a unique spectrum of CNS infections, we created an algorithm that identified HIV-positive patients and diagnosed those with cryptococcal meningitis. After cryptococcal infection was ruled out, previously published algorithms were used to assist in the early diagnosis and treatment of bacterial meningitis, tuberculous meningitis, and other common central nervous system infections. In retrospective comparison with current management, the CNS algorithm reduced overall time to diagnosis and initiate treatment of cryptococcal meningitis from 3.5 days to less than 1 day.
CONCLUSIONS:
CNS infections are complex and difficult to diagnose and treat in Uganda, and are associated with high in-hospital mortality. A clinical algorithm may significantly decrease the time to diagnose and treat CNS infections in a resource-limited setting. |
Kamya, MR.; Mayanja-Kizza, H.; Kambugu, A.; Bakeera-Kitaka, S.; Semitala, F.; Mwebaze-Songa, P.; Castelnuovo, B.; Schaefer, P.; Spacek, LA.; Gasasira, AF.; Katabira, E.; Colebunders, R.; Quinn, TC.; Ronald, A.; Thomas, DL.; Kekitiinwa, A.; for AIDS Care, Academic Alliance; in Africa., Prevention Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy. Journal Article In: JAIDS Journal of Acquired Immune Deficiency Syndromes, vol. 46, no. 2, pp. 187-93, 2007. @article{Kamya2007,
title = {Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy.},
author = {MR. Kamya and H. Mayanja-Kizza and A. Kambugu and S. Bakeera-Kitaka and F. Semitala and P. Mwebaze-Songa and B. Castelnuovo and P. Schaefer and LA. Spacek and AF. Gasasira and E. Katabira and R. Colebunders and TC. Quinn and A. Ronald and DL. Thomas and A. Kekitiinwa and Academic Alliance for AIDS Care and Prevention in Africa.},
doi = {10.1097/QAI.0b013e31814278c0},
year = {2007},
date = {2007-10-01},
journal = {JAIDS Journal of Acquired Immune Deficiency Syndromes},
volume = {46},
number = {2},
pages = {187-93},
abstract = {BACKGROUND:
HIV RNA viral load testing is costly and is generally unavailable in resource-limited settings. We identified predictors of viral failure and documented genotypic mutations in a subset of patients with viral failure after 12 months on antiretroviral therapy (ART).
METHODS:
From April 2004 to June 2005, consecutive treatment-naive patients beginning ART at a university clinic in Uganda were enrolled. Clinical information, CD4 cell count, and HIV RNA level were collected at baseline and every 3 to 6 months. Independent predictors of viral failure were identified using multivariate logistic regression. Genotypic drug resistance for 8 patients with viral failure at 12 months was measured at baseline and at 6 and 12 months.
RESULTS:
Five hundred twenty-six adults and 250 children (0 to 18 years of age) were started on first-line ART regimens and followed for 12 months. Outcomes could not be assessed in 13% of patients (79 died and 21 were withdrawn). Children were almost twice as likely to have viral failure compared with adults (26% vs. 14%; P = 0.0001). In adults, the sole independent predictor of viral failure was treatment with stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) versus zidovudine (ZDV)/3TC/efavirenz (EFV) (odds ratio [OR] = 2.59, 95% confidence interval [CI]: 1.20 to 5.59). In children, independent predictors of viral failure included male gender (OR = 2.44, 95% CI: 1.20 to 4.93), baseline CD4% <5 (OR = 2.69, 95% CI: 1.28 to 5.63), and treatment with d4T/3TC/NVP versus ZDV/3TC/EFV (OR = 2.46, 95% CI: 1.23 to 4.90). All 8 patients with viral breakthrough and genotypic drug resistance results had nonnucleoside reverse transcriptase inhibitor (NNRTI)- and 3TC-associated mutations.
CONCLUSIONS:
These data demonstrate the effectiveness of ART in a low-resource setting. Children and patients of all ages taking the d4T/3TC/NVP regimen were more likely to have viral failure. Our data suggest that viral failure occurring 6 months or more after the start of ART regimens commonly used in Uganda is likely to be associated with NNRTI- and 3TC-resistant virus.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
HIV RNA viral load testing is costly and is generally unavailable in resource-limited settings. We identified predictors of viral failure and documented genotypic mutations in a subset of patients with viral failure after 12 months on antiretroviral therapy (ART).
METHODS:
From April 2004 to June 2005, consecutive treatment-naive patients beginning ART at a university clinic in Uganda were enrolled. Clinical information, CD4 cell count, and HIV RNA level were collected at baseline and every 3 to 6 months. Independent predictors of viral failure were identified using multivariate logistic regression. Genotypic drug resistance for 8 patients with viral failure at 12 months was measured at baseline and at 6 and 12 months.
RESULTS:
Five hundred twenty-six adults and 250 children (0 to 18 years of age) were started on first-line ART regimens and followed for 12 months. Outcomes could not be assessed in 13% of patients (79 died and 21 were withdrawn). Children were almost twice as likely to have viral failure compared with adults (26% vs. 14%; P = 0.0001). In adults, the sole independent predictor of viral failure was treatment with stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) versus zidovudine (ZDV)/3TC/efavirenz (EFV) (odds ratio [OR] = 2.59, 95% confidence interval [CI]: 1.20 to 5.59). In children, independent predictors of viral failure included male gender (OR = 2.44, 95% CI: 1.20 to 4.93), baseline CD4% <5 (OR = 2.69, 95% CI: 1.28 to 5.63), and treatment with d4T/3TC/NVP versus ZDV/3TC/EFV (OR = 2.46, 95% CI: 1.23 to 4.90). All 8 patients with viral breakthrough and genotypic drug resistance results had nonnucleoside reverse transcriptase inhibitor (NNRTI)- and 3TC-associated mutations.
CONCLUSIONS:
These data demonstrate the effectiveness of ART in a low-resource setting. Children and patients of all ages taking the d4T/3TC/NVP regimen were more likely to have viral failure. Our data suggest that viral failure occurring 6 months or more after the start of ART regimens commonly used in Uganda is likely to be associated with NNRTI- and 3TC-resistant virus. |
Songa, PM.; Castelnuovo, B.; Mugasha, EB.; Ocama, P.; Kambugu, A. Symptomatic hyperlactatemia associated with nucleoside analogue reverse-transcriptase inhibitor use in HIV-infected patients: a report of 24 cases in a resource-limited setting (Uganda). Journal Article In: Clinical Infectious Diseases, vol. 45, no. 4, pp. 514-7, 2007. @article{Songa2007,
title = {Symptomatic hyperlactatemia associated with nucleoside analogue reverse-transcriptase inhibitor use in HIV-infected patients: a report of 24 cases in a resource-limited setting (Uganda).},
author = {PM. Songa and B. Castelnuovo and EB. Mugasha and P. Ocama and A. Kambugu},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Symptomatic-hyperlactatemia-associated-with-nucleoside-analogue-reverse-transcriptase-inhibitor-use-in-HIV-infected-patients-a-report-of-24-cases-in-a-resource-limited-setting-Uganda.pdf},
doi = {10.1086/520023},
year = {2007},
date = {2007-08-15},
journal = {Clinical Infectious Diseases},
volume = {45},
number = {4},
pages = {514-7},
abstract = {We describe 24 Ugandan patients with human immunodeficiency virus infection who developed symptomatic hyperlactatemia associated with the use of nucleoside analogues. All patients were receiving combination therapy that contained stavudine. The median serum lactate level was 6.6 mmol/L. All patients had their antiretroviral treatment regimen discontinued. Hospital admission was required for 5 patients. Five patients died.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
We describe 24 Ugandan patients with human immunodeficiency virus infection who developed symptomatic hyperlactatemia associated with the use of nucleoside analogues. All patients were receiving combination therapy that contained stavudine. The median serum lactate level was 6.6 mmol/L. All patients had their antiretroviral treatment regimen discontinued. Hospital admission was required for 5 patients. Five patients died. |
Wanyama, J.; Castelnuovo, B.; Wandera, B.; Mwebaze, P.; Kambugu, A.; Bangsberg, DR.; Kamya, MR. Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda. Journal Article In: AIDS (London, England), vol. 21, no. 11, pp. 1486-7, 2007. @article{Wanyama2007,
title = {Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda.},
author = {J. Wanyama and B. Castelnuovo and B. Wandera and P. Mwebaze and A. Kambugu and DR. Bangsberg and MR. Kamya},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Belief-in-divine-healing-can-be-a-barrier-to-antiretroviral-therapy-adherence-in-Uganda..pdf},
doi = {10.1097/QAD.0b013e32823ecf7f},
year = {2007},
date = {2007-07-11},
journal = {AIDS (London, England)},
volume = {21},
number = {11},
pages = {1486-7},
abstract = {Although recent data suggest high levels of adherence to expanding antiretroviral therapy (ART) programmes in resource-limited settings, the culture-specific barriers to adherence are poorly understood. In a prospective observational study, we found that 1.2% of patients discontinued ART because of a belief in spiritual healing. Spiritual beliefs should be an important part of ART adherence counselling in resource-limited settings, requiring close collaboration between HIV care programmes and religious leaders to identify common goals and ensure successful treatment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Although recent data suggest high levels of adherence to expanding antiretroviral therapy (ART) programmes in resource-limited settings, the culture-specific barriers to adherence are poorly understood. In a prospective observational study, we found that 1.2% of patients discontinued ART because of a belief in spiritual healing. Spiritual beliefs should be an important part of ART adherence counselling in resource-limited settings, requiring close collaboration between HIV care programmes and religious leaders to identify common goals and ensure successful treatment. |
Byakika-Kibwika, P; Ddumba, E; Kamya, M Effect of HIV-1 infection on malaria treatment outcome in Ugandan patients. Journal Article In: African Health Sciences, vol. 7, no. 2, pp. 86-92, 2007. @article{Byakika-Kibwika2007,
title = {Effect of HIV-1 infection on malaria treatment outcome in Ugandan patients.},
author = {P Byakika-Kibwika and E Ddumba and M Kamya},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Effect-of-HIV-1-infection-on-malaria-treatment-outcome-in-Ugandan-patients..pdf},
year = {2007},
date = {2007-06-01},
journal = {African Health Sciences},
volume = {7},
number = {2},
pages = {86-92},
abstract = {Background: Malaria and HIV-1 infection cause significant morbidity and mortality in sub-Saharan Africa. HIV-1 increases risk for malaria with the risk increasing as immunity declines.The effect of HIV-1 infection on antimalarial treatment outcome is still inconclusive.
Objective: To compare antimalarial treatment outcome among HIV-1 positive and negative patients with acute uncomplicated falciparum malaria treated with chloroquine plus sulfadoxine-pyrimethamine (CQ+SP).
Methods: Ninety eight HIV-1 positive patients aged 18 months or older with acute uncomplicated falciparum malaria were treated with CQ+SP and followed for 28 days to monitor outcome.Treatment outcome of HIV-1 positive patients was compared to that of 193 HIV-1 negative historical controls.The primary study outcome for both groups was treatment failure.
Results: HIV-1 positive patients older than 5 years of age were less likely to have treatment failure compared to HIV-1 negative patients in the same age group (RR 0.59 95% CI 0.4- 0.8, p α 0.001) and HIV-1 positive patients on routine cotrimoxazole prophylaxis were less likely to have treatment failure following CQ+SP treatment compared to HIV negative patients (RR 0.6 95% CI 0.43-0.92, p = 0.006).There was no difference in treatment outcome according to HIV-1 status for children younger than 5 years of age.
Conclusions: Adherence to cotrimoxazole prophylaxis should be reinforced in HIV positive patients and it should be reassessed if these patients present with acute episodes of malaria.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Malaria and HIV-1 infection cause significant morbidity and mortality in sub-Saharan Africa. HIV-1 increases risk for malaria with the risk increasing as immunity declines.The effect of HIV-1 infection on antimalarial treatment outcome is still inconclusive.
Objective: To compare antimalarial treatment outcome among HIV-1 positive and negative patients with acute uncomplicated falciparum malaria treated with chloroquine plus sulfadoxine-pyrimethamine (CQ+SP).
Methods: Ninety eight HIV-1 positive patients aged 18 months or older with acute uncomplicated falciparum malaria were treated with CQ+SP and followed for 28 days to monitor outcome.Treatment outcome of HIV-1 positive patients was compared to that of 193 HIV-1 negative historical controls.The primary study outcome for both groups was treatment failure.
Results: HIV-1 positive patients older than 5 years of age were less likely to have treatment failure compared to HIV-1 negative patients in the same age group (RR 0.59 95% CI 0.4- 0.8, p α 0.001) and HIV-1 positive patients on routine cotrimoxazole prophylaxis were less likely to have treatment failure following CQ+SP treatment compared to HIV negative patients (RR 0.6 95% CI 0.43-0.92, p = 0.006).There was no difference in treatment outcome according to HIV-1 status for children younger than 5 years of age.
Conclusions: Adherence to cotrimoxazole prophylaxis should be reinforced in HIV positive patients and it should be reassessed if these patients present with acute episodes of malaria. |
Meya, DB.; Katabira, E.; Otim, M.; Ronald, A.; Colebunders, R.; Njama, D.; Mayanja-Kizza, H.; Whalen, CC.; Sande, M. Functional adrenal insufficiency among critically ill patients with human immunodeficiency virus in a resource-limited setting. Journal Article In: African Health Sciences, vol. 7, no. 2, pp. 101-7, 2007. @article{Meya2007b,
title = {Functional adrenal insufficiency among critically ill patients with human immunodeficiency virus in a resource-limited setting.},
author = {DB. Meya and E. Katabira and M. Otim and A. Ronald and R. Colebunders and D. Njama and H. Mayanja-Kizza and CC. Whalen and M. Sande},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Functional-adrenal-insufficiency-among-critically-ill-patients-with-human-immunodeficiency-virus-in-a-resource-limited-setting..pdf},
doi = {10.5555/afhs.2007.7.2.101},
year = {2007},
date = {2007-06-01},
journal = {African Health Sciences},
volume = {7},
number = {2},
pages = {101-7},
abstract = {Background: Functional adrenal insufficiency (FAI) is associated with increased mortality and is defined as subnormal cortisol production during acute severe illness.
Methods: After screening 200 adult patients admitted in the medical emergency unit of Mulago Hospital, Kampala, Uganda, 113 critically ill HIV-infected adults not receiving corticosteroids were enrolled after obtaining informed consent to determine the prevalence and factors associated with FAI.
Results: Functional adrenal insufficiency, defined in this study as morning total serum cortisol level of ≤ 25 μg/dl, was detected in 21 (19%) of 113 patients (95% CI 11-26%). Eosinophilia (>3%) occurred in 52% (11 of 21) patients with FAI compared to 24% (22 of 92) patients with normal adrenal function (p= 0.01). Factors predicting FAI on multivariate analysis were use of rifampicin and eosinophilia.The mortality rate among patients with FAI (19%) was not significantly different when compared to that among patients with a normal cortisol response (33%) (p=0.221). Hyponatremia, hypoglycemia, hyperkalemia, postural hypotension and the use of ketoconazole were not associated with FAI in this study.
Conclusion: The diagnosis of FAI should be considered in severely ill patients with stage IV HIV disease using rifampicin or those found to have unexplained eosinophilia. Further studies to determine benefits of corticosteroids in critically ill HIV patients are needed in this setting.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Functional adrenal insufficiency (FAI) is associated with increased mortality and is defined as subnormal cortisol production during acute severe illness.
Methods: After screening 200 adult patients admitted in the medical emergency unit of Mulago Hospital, Kampala, Uganda, 113 critically ill HIV-infected adults not receiving corticosteroids were enrolled after obtaining informed consent to determine the prevalence and factors associated with FAI.
Results: Functional adrenal insufficiency, defined in this study as morning total serum cortisol level of ≤ 25 μg/dl, was detected in 21 (19%) of 113 patients (95% CI 11-26%). Eosinophilia (>3%) occurred in 52% (11 of 21) patients with FAI compared to 24% (22 of 92) patients with normal adrenal function (p= 0.01). Factors predicting FAI on multivariate analysis were use of rifampicin and eosinophilia.The mortality rate among patients with FAI (19%) was not significantly different when compared to that among patients with a normal cortisol response (33%) (p=0.221). Hyponatremia, hypoglycemia, hyperkalemia, postural hypotension and the use of ketoconazole were not associated with FAI in this study.
Conclusion: The diagnosis of FAI should be considered in severely ill patients with stage IV HIV disease using rifampicin or those found to have unexplained eosinophilia. Further studies to determine benefits of corticosteroids in critically ill HIV patients are needed in this setting. |
Vekemans, M.; John, L.; Colebunders, R. When to switch for antiretroviral treatment failure in resource-limited settings? Journal Article In: AIDS (London, England), vol. 21, no. 9, pp. 1205-6, 2007, ISBN: 0269-9370. @article{Vekemans2007,
title = {When to switch for antiretroviral treatment failure in resource-limited settings?},
author = {M. Vekemans and L. John and R. Colebunders },
doi = {10.1097/QAD.0b013e3281c617e8},
isbn = {0269-9370},
year = {2007},
date = {2007-05-31},
journal = {AIDS (London, England)},
volume = {21},
number = {9},
pages = {1205-6},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Meya, DB.; McAdam, KP. The TB pandemic: an old problem seeking new solutions Journal Article In: vol. 1, no. 4, pp. 309-29, 2007. @article{Meya2007,
title = {The TB pandemic: an old problem seeking new solutions},
author = {DB. Meya and KP. McAdam },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/The-TB-pandemic-an-old-problem-seeking-new-solutions.pdf},
doi = {10.1111/j.1365-2796.2007.01795.x},
year = {2007},
date = {2007-04-26},
volume = {1},
number = {4},
pages = {309-29},
abstract = {Tuberculosis (TB) continues to kill more than 2 million people globally each year. Annual TB case notification rates have risen up to fourfold since the mid-1980s, with the highest rate of 1000/100,000 around Cape Town, South Africa. There is an urgent need for novel diagnostic methods and preventive vaccines to control this epidemic. The rising incidence of TB has been attributed to HIV co-infection especially in developing countries. The threat of drug resistance arising from ineffective TB treatment programmes is looming and could potentially lead to loss of any gains made in controlling the disease globally.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Tuberculosis (TB) continues to kill more than 2 million people globally each year. Annual TB case notification rates have risen up to fourfold since the mid-1980s, with the highest rate of 1000/100,000 around Cape Town, South Africa. There is an urgent need for novel diagnostic methods and preventive vaccines to control this epidemic. The rising incidence of TB has been attributed to HIV co-infection especially in developing countries. The threat of drug resistance arising from ineffective TB treatment programmes is looming and could potentially lead to loss of any gains made in controlling the disease globally. |
Robertson, Kevin R; Nakasujja, Noeline; Wong, Matthew; Musisi, Seggane; Katabira, Elly; Parsons, Thomas D; Ronald, Allan; Sacktor, Ned Pattern of neuropsychological performance among HIV positive patients in Uganda. Journal Article In: BMC Neurology, vol. 7, no. 8, pp. 1-7, 2007. @article{Robertson2007,
title = {Pattern of neuropsychological performance among HIV positive patients in Uganda.},
author = {Kevin R Robertson and Noeline Nakasujja and Matthew Wong and Seggane Musisi and Elly Katabira and Thomas D Parsons and Allan Ronald and Ned Sacktor},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Pattern-of-neuropsychological-performance-among-HIV-positive-patients-in-Uganda..pdf},
doi = {10.1186/1471-2377-7-8},
year = {2007},
date = {2007-04-05},
journal = {BMC Neurology},
volume = {7},
number = {8},
pages = {1-7},
abstract = {BACKGROUND:
Few studies have examined cognitive functioning of HIV positive patients in sub-Saharan Africa. It cannot be assumed that HIV positive patients in Africa exhibit the same declines as patients in high-resource settings, since there are differences that may influence cognitive functioning including nutrition, history of concomitant disease, and varying HIV strains, among other possibilities. Part of the difficulty of specifying abnormalities in neuropsychological functioning among African HIV positive patients is that there are no readily available African normative databases. The purpose of the current study was to evaluate the pattern of neuropsychological performance in a sample of HIV positive patients in comparison to HIV negative control subjects in Uganda.
METHODS:
The neuropsychological test scores of 110 HIV positive patients (WHO Stage 2, n = 21; WHO Stage 3, n = 69; WHO Stage 4, n = 20) were contrasted with those of 100 control subjects on measures of attention/concentration, mental flexibility, learning/memory, and motor functioning.
RESULTS:
Analysis of covariance (ANCOVA) revealed significant group differences on measures of verbal learning and memory, speed of processing, attention and executive functioning between HIV seropositive and seronegative subjects.
CONCLUSION:
Ugandan patients with HIV demonstrated relative deficits on measures of verbal learning and memory, speed of processing, attention, and executive functioning compared to HIV negative controls. These results from a resource limited region where clades A and D are prevalent are consistent with previous findings in the developed world where clade B predominates.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
Few studies have examined cognitive functioning of HIV positive patients in sub-Saharan Africa. It cannot be assumed that HIV positive patients in Africa exhibit the same declines as patients in high-resource settings, since there are differences that may influence cognitive functioning including nutrition, history of concomitant disease, and varying HIV strains, among other possibilities. Part of the difficulty of specifying abnormalities in neuropsychological functioning among African HIV positive patients is that there are no readily available African normative databases. The purpose of the current study was to evaluate the pattern of neuropsychological performance in a sample of HIV positive patients in comparison to HIV negative control subjects in Uganda.
METHODS:
The neuropsychological test scores of 110 HIV positive patients (WHO Stage 2, n = 21; WHO Stage 3, n = 69; WHO Stage 4, n = 20) were contrasted with those of 100 control subjects on measures of attention/concentration, mental flexibility, learning/memory, and motor functioning.
RESULTS:
Analysis of covariance (ANCOVA) revealed significant group differences on measures of verbal learning and memory, speed of processing, attention and executive functioning between HIV seropositive and seronegative subjects.
CONCLUSION:
Ugandan patients with HIV demonstrated relative deficits on measures of verbal learning and memory, speed of processing, attention, and executive functioning compared to HIV negative controls. These results from a resource limited region where clades A and D are prevalent are consistent with previous findings in the developed world where clade B predominates. |
Colebunders, R.; T, Bukenya; Pakker, N.; Smith, O.; Boeynaems, V.; Waldron, J.; Muganga, A. M.; Twijukye, C.; McAdam, K.; Katabira, E. Assessment of the patient flow at the infectious diseases institute out-patient clinic, Kampala, Uganda. Journal Article In: AIDS Care, vol. 19, no. 2, pp. 149-51, 2007. @article{Colebunders2007,
title = {Assessment of the patient flow at the infectious diseases institute out-patient clinic, Kampala, Uganda.},
author = {R. Colebunders and T, Bukenya and N. Pakker and O. Smith and V. Boeynaems and J. Waldron and A.M. Muganga and C. Twijukye and K. McAdam and E. Katabira },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Assessment-of-the-patient-flow-at-the-infectious-diseases-institute-out-patient-clinic-Kampala-Uganda.pdf},
doi = {10.1080/09540120600762078},
year = {2007},
date = {2007-02-12},
journal = {AIDS Care},
volume = {19},
number = {2},
pages = {149-51},
abstract = {In order to cope with the increasing patient load, a study was performed to identify bottlenecks in patient flow at the Infectious Diseases out-patient clinic in Kampala, Uganda on 10 January 2005. On a standardised questionnaire we recorded for all patients: the time they presented at reception, waiting times for different services and in- and out times for nursing, counselling and doctor visits. 250 patients visited the clinic the study day: 36 (20 per cent) were asymptomatic; 133 (75 per cent) symptomatic but not critically ill and 8 (4.5 per cent) severely ill; 63 (37.5 per cent) were on antiretroviral treatment. The median time spend at the clinic was 157 minutes (range 22-426). The median time from reception to the triage/vital-signs measuring unit was 34 minutes (range 3-92), from triage nurse to doctor 51 minutes (range 1-205), from doctor to pharmacy 24 minutes (range 5-292). The median waiting time at the pharmacy was 30 minutes (range 10-175). Based on these results, organisational changes were proposed. A similar methodology could be used to evaluate and compare health service delivery systems for persons with HIV infection in Africa in order to identify the most efficient models of care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In order to cope with the increasing patient load, a study was performed to identify bottlenecks in patient flow at the Infectious Diseases out-patient clinic in Kampala, Uganda on 10 January 2005. On a standardised questionnaire we recorded for all patients: the time they presented at reception, waiting times for different services and in- and out times for nursing, counselling and doctor visits. 250 patients visited the clinic the study day: 36 (20 per cent) were asymptomatic; 133 (75 per cent) symptomatic but not critically ill and 8 (4.5 per cent) severely ill; 63 (37.5 per cent) were on antiretroviral treatment. The median time spend at the clinic was 157 minutes (range 22-426). The median time from reception to the triage/vital-signs measuring unit was 34 minutes (range 3-92), from triage nurse to doctor 51 minutes (range 1-205), from doctor to pharmacy 24 minutes (range 5-292). The median waiting time at the pharmacy was 30 minutes (range 10-175). Based on these results, organisational changes were proposed. A similar methodology could be used to evaluate and compare health service delivery systems for persons with HIV infection in Africa in order to identify the most efficient models of care. |
Wong, MH.; Robertson, K.; Nakasujja, N.; Skolasky, R.; Musisi, S.; Katabira, E.; McArthur, JC.; Ronald, A.; Sacktor, N. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Journal Article In: Neurology, vol. 68, no. 5, pp. 350-5, 2007. @article{Wong2007,
title = {Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa.},
author = {MH. Wong and K. Robertson and N. Nakasujja and R. Skolasky and S. Musisi and E. Katabira and JC. McArthur and A. Ronald and N. Sacktor },
doi = {https://doi.org/10.1212/01.wnl.0000252811.48891.6d},
year = {2007},
date = {2007-01-30},
journal = {Neurology},
volume = {68},
number = {5},
pages = {350-5},
abstract = {OBJECTIVE: To measure the frequency and associated risk factors of HIV dementia in an HIV clinic in Kampala, Uganda. METHODS: We systematically sampled 78 HIV-seropositive (HIV+) patients from an ambulatory HIV clinic. Participants underwent detailed sociodemographic, medical history, functional, neurologic, and neuropsychological evaluations. One hundred HIV-negative patients were recruited to provide normative data for the neuropsychological tests. A logistic regression model was constructed to determine risk factors associated with the diagnosis of HIV dementia. RESULTS: Thirty-one percent (24 of 78) of the HIV+ patients had HIV dementia. Advanced age and low CD4(+) T-lymphocyte count (CD4 count) were the only variables identified as significant risk factors in the logistic regression model. Each additional 10 years of age conferred a greater than twofold risk of HIV dementia (OR 2.06, 95% CI: 1.05 to 4.07; p},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To measure the frequency and associated risk factors of HIV dementia in an HIV clinic in Kampala, Uganda. METHODS: We systematically sampled 78 HIV-seropositive (HIV+) patients from an ambulatory HIV clinic. Participants underwent detailed sociodemographic, medical history, functional, neurologic, and neuropsychological evaluations. One hundred HIV-negative patients were recruited to provide normative data for the neuropsychological tests. A logistic regression model was constructed to determine risk factors associated with the diagnosis of HIV dementia. RESULTS: Thirty-one percent (24 of 78) of the HIV+ patients had HIV dementia. Advanced age and low CD4(+) T-lymphocyte count (CD4 count) were the only variables identified as significant risk factors in the logistic regression model. Each additional 10 years of age conferred a greater than twofold risk of HIV dementia (OR 2.06, 95% CI: 1.05 to 4.07; p |
2006
|
Weaver, MR.; Nakitto, C.; Schneider, G.; Kamya, MR.; Kambugu, A.; Lukwago, R.; Ronald, A.; K, McAdam; Sande, MA. Measuring the outcomes of a comprehensive HIV care course: pilot test at the Infectious Diseases Institute, Kampala, Uganda. Journal Article In: JAIDS Journal of Acquired Immune Deficiency Syndromes, vol. 43, no. 3, pp. 293-303, 2006. @article{Weaver2006,
title = {Measuring the outcomes of a comprehensive HIV care course: pilot test at the Infectious Diseases Institute, Kampala, Uganda.},
author = {MR. Weaver and C. Nakitto and G. Schneider and MR. Kamya and A. Kambugu and R. Lukwago and A. Ronald and K, McAdam and MA. Sande },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Measuring-the-Outcomes-of-a-Comprehensive-HIV-Care-Course-1.pdf},
doi = {10.1097/01.qai.0000243047.42827.97},
year = {2006},
date = {2006-11-01},
journal = {JAIDS Journal of Acquired Immune Deficiency Syndromes},
volume = {43},
number = {3},
pages = {293-303},
abstract = {OBJECTIVE: To evaluate the effects of the Infectious Diseases Institute's 4-week course for African doctors on comprehensive management of HIV including antiretroviral therapy on four outcomes: (1) clinical skills, (2) clinical activities, (3) monitoring of HIV patients, and (4) training activities DESIGN: Clinical exam at beginning and end of course and at follow-up 3 to 4 months later, and a cross-section telephone survey. METHODS: Forty-seven doctors attending the course (October 2004, November 2004, March 2005, and April 2005) agreed to participate. A 17-item Clinical Exam Checklist was used to assess clinical skills. A telephone survey was conducted 1 month after the course to collect data in four areas: clinical activities, monitoring of HIV patients, case studies on initiation of ART, and training activities. RESULTS: The course improved the clinical skills of doctors. Between the beginning and end of the course, their clinical skills improved significantly in 11 of 17 areas (n = 34). Between the end of the course and follow-up, their skills improved significantly in three areas (n = 14). The trainees were practicing HIV care and training. The telephone survey (n = 46) showed that 93% of trainees treated HIV patients, 35% provided training on HIV, and 47% monitored the weight of the last HIV patient treated (patient's weight was a clinical end point to measure health status). At follow-up, everyone provided training and trained an average of 20 people per month.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To evaluate the effects of the Infectious Diseases Institute's 4-week course for African doctors on comprehensive management of HIV including antiretroviral therapy on four outcomes: (1) clinical skills, (2) clinical activities, (3) monitoring of HIV patients, and (4) training activities DESIGN: Clinical exam at beginning and end of course and at follow-up 3 to 4 months later, and a cross-section telephone survey. METHODS: Forty-seven doctors attending the course (October 2004, November 2004, March 2005, and April 2005) agreed to participate. A 17-item Clinical Exam Checklist was used to assess clinical skills. A telephone survey was conducted 1 month after the course to collect data in four areas: clinical activities, monitoring of HIV patients, case studies on initiation of ART, and training activities. RESULTS: The course improved the clinical skills of doctors. Between the beginning and end of the course, their clinical skills improved significantly in 11 of 17 areas (n = 34). Between the end of the course and follow-up, their skills improved significantly in three areas (n = 14). The trainees were practicing HIV care and training. The telephone survey (n = 46) showed that 93% of trainees treated HIV patients, 35% provided training on HIV, and 47% monitored the weight of the last HIV patient treated (patient's weight was a clinical end point to measure health status). At follow-up, everyone provided training and trained an average of 20 people per month. |
Colebunders, R.; John, L.; V, Huyst; Kambugu, A.; Scano, F.; Lynen, L. Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources. Journal Article In: The International Journal of Tuberculosis and Lung Disease,, vol. 10, no. 9, pp. 946-53, 2006. @article{Colebunders2006e,
title = {Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources.},
author = {R. Colebunders and L. John and V, Huyst and A. Kambugu and F. Scano and L. Lynen },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Tuberculosis-immune-reconstitution-inflammatory-syndrome-in-countries-with-limited-resources.pdf},
year = {2006},
date = {2006-09-01},
journal = {The International Journal of Tuberculosis and Lung Disease,},
volume = {10},
number = {9},
pages = {946-53},
abstract = {Mycobacterium tuberculosis infection accounts for probably one third of human immunodeficiency virus (HIV) related immune reconstitution inflammatory syndrome (IRIS) events, particularly in developing countries where HIV and tuberculosis (TB) co-infection is very common. Small cohort studies of HIV-positive patients with active TB treated with antiretroviral therapy (ART) suggest an incidence of TB IRIS varying between 11% and 45%. Risk factors for TB IRIS that have been suggested in certain studies but not in others include: starting ART within 6 weeks of starting TB treatment; extra-pulmonary or disseminated disease; a low CD4+ lymphocyte count and a high viral load at the start of ART; and a good immunological and virological response during highly active antiretroviral therapy (HAART). It is important to agree on a clinical case definition of TB IRIS that could be used in resource-limited settings. Such a case definition could be used to determine the exact incidence and consequences of TB IRIS and would be valuable worldwide in clinical trials that are needed to answer questions on how this phenomenon could be prevented and treated.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Mycobacterium tuberculosis infection accounts for probably one third of human immunodeficiency virus (HIV) related immune reconstitution inflammatory syndrome (IRIS) events, particularly in developing countries where HIV and tuberculosis (TB) co-infection is very common. Small cohort studies of HIV-positive patients with active TB treated with antiretroviral therapy (ART) suggest an incidence of TB IRIS varying between 11% and 45%. Risk factors for TB IRIS that have been suggested in certain studies but not in others include: starting ART within 6 weeks of starting TB treatment; extra-pulmonary or disseminated disease; a low CD4+ lymphocyte count and a high viral load at the start of ART; and a good immunological and virological response during highly active antiretroviral therapy (HAART). It is important to agree on a clinical case definition of TB IRIS that could be used in resource-limited settings. Such a case definition could be used to determine the exact incidence and consequences of TB IRIS and would be valuable worldwide in clinical trials that are needed to answer questions on how this phenomenon could be prevented and treated. |
C.L., Karp; R., Colebunders The Human Immunodeficiency Virus and Co-Infecting Tropical Infectious Diseases Book 2, Tropical infectious diseases: principles, pathogens & practice / Guerrant, Richard L. [edit.], 2006. @book{Karp2006,
title = {The Human Immunodeficiency Virus and Co-Infecting Tropical Infectious Diseases},
author = {Karp C.L. and Colebunders R. },
url = {https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30184-8/fulltext},
doi = {10.1016/j.cmi.2018.02.011},
year = {2006},
date = {2006-08-01},
volume = {24},
number = {8},
publisher = {Tropical infectious diseases: principles, pathogens & practice / Guerrant, Richard L. [edit.]},
edition = {2},
abstract = {Background
Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies.
Aim
To summarize recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria.
Sources
A narrative literature review by searching the MEDLINE database, and recent conference abstracts.
Content
Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalized patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum β-lactamase-producing Enterobacteriaceae and fluoroquinolone-resistant Salmonella enterica. Among those with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important.
Implications
Understanding the local epidemiology of fever aetiology, and the use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalized patients infected with organisms that are not susceptible to empiric antibacterial regimens.},
keywords = {},
pubstate = {published},
tppubtype = {book}
}
Background
Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies.
Aim
To summarize recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria.
Sources
A narrative literature review by searching the MEDLINE database, and recent conference abstracts.
Content
Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalized patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum β-lactamase-producing Enterobacteriaceae and fluoroquinolone-resistant Salmonella enterica. Among those with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important.
Implications
Understanding the local epidemiology of fever aetiology, and the use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalized patients infected with organisms that are not susceptible to empiric antibacterial regimens. |
Colebunders, Robert; Lynen, Lut; Meya, David; Reynolds, Steven; Moses, Kamya Evaluating a model for monitoring the virological efficacy of antiretroviral treatment in resource-limited settings.- Author's Reply Journal Article In: The Lancet Infectious Diseases, vol. 6, no. 7, pp. 387-388, 2006. @article{Colebunders2006c,
title = {Evaluating a model for monitoring the virological efficacy of antiretroviral treatment in resource-limited settings.- Author's Reply},
author = {Robert Colebunders and Lut Lynen and David Meya and Steven Reynolds and Kamya Moses},
doi = {http://login.research4life.org/tacsgr1doi_org/10.1016/S1473-3099(06)70499-6},
year = {2006},
date = {2006-07-01},
journal = {The Lancet Infectious Diseases},
volume = {6},
number = {7},
pages = {387-388},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Colebunders, R.; Castelnuovo, B.; Byakwaga, H. HIV Eosinophilic Folliculitis in Uganda Journal Article In: Archives of Dematology, vol. 142, no. 7, pp. 934-5, 2006. @article{Colebunders2006d,
title = {HIV Eosinophilic Folliculitis in Uganda},
author = {R. Colebunders and B. Castelnuovo and H. Byakwaga},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/HIV-eosinophilic-folliculitis-in-Uganda.pdf},
doi = { 10.1001/archderm.142.7.934-b},
year = {2006},
date = {2006-07-01},
journal = {Archives of Dematology},
volume = {142},
number = {7},
pages = {934-5},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Wanyenze, R.; Kamya, M.; Liechty, CA.; Ronald, A.; Guzman, DJ.; Wabwire-Mangen, F.; Mayanja-Kizza, H.; Bangsberg, DR. HIV counseling and testing practices at an urban hospital in Kampala, Uganda. Journal Article In: AIDS and Behavior, vol. 10, no. 4, pp. 361-7, 2006, ISBN: 1573-3254. @article{Wanyenze2006,
title = {HIV counseling and testing practices at an urban hospital in Kampala, Uganda.},
author = {R. Wanyenze and M. Kamya and CA. Liechty and A. Ronald and DJ. Guzman and F. Wabwire-Mangen and H. Mayanja-Kizza and DR. Bangsberg},
doi = {https://doi.org/10.1007/s10461-005-9035-9},
isbn = {1573-3254},
year = {2006},
date = {2006-07-01},
journal = {AIDS and Behavior},
volume = {10},
number = {4},
pages = {361-7},
abstract = {While the majority of medical inpatients in Uganda are assumed to be HIV-positive, HIV testing is limited in inpatient settings. This study describes HIV testing practices and risk behavior among medical inpatients at an urban hospital in Uganda. We interviewed 395 adults on the day of discharge. Overall, 46% tested for HIV before or during admission. Of the 20% tested during hospitalization, 64% were HIV-positive. Among 47% who had sex in the previous year, only 14% used condoms consistently and only 20% knew the HIV status of their sexual partner, indicating that participants would benefit from risk-reduction counseling. Yet, only 26% of participants tested during hospitalization received post-test counseling. Half of the participants with HIV-related illnesses left the hospital without being offered the test, a missed opportunity for HIV prevention counseling and care. The findings indicate that hospitals are important venues for HIV counseling and testing.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
While the majority of medical inpatients in Uganda are assumed to be HIV-positive, HIV testing is limited in inpatient settings. This study describes HIV testing practices and risk behavior among medical inpatients at an urban hospital in Uganda. We interviewed 395 adults on the day of discharge. Overall, 46% tested for HIV before or during admission. Of the 20% tested during hospitalization, 64% were HIV-positive. Among 47% who had sex in the previous year, only 14% used condoms consistently and only 20% knew the HIV status of their sexual partner, indicating that participants would benefit from risk-reduction counseling. Yet, only 26% of participants tested during hospitalization received post-test counseling. Half of the participants with HIV-related illnesses left the hospital without being offered the test, a missed opportunity for HIV prevention counseling and care. The findings indicate that hospitals are important venues for HIV counseling and testing. |
Group, DART Virology; Team, Trial Virological response to a triple nucleoside/nucleotide analogue regimen over 48 weeks in HIV-1-infected adults in Africa Journal Article In: AIDS (London, England), vol. 20, no. 10, pp. 1391-9, 2006, ISBN: 0269-9370. @article{Group2006,
title = {Virological response to a triple nucleoside/nucleotide analogue regimen over 48 weeks in HIV-1-infected adults in Africa},
author = {DART Virology Group and Trial Team },
doi = {10.1097/01.aids.0000233572.59522.45},
isbn = { 0269-9370},
year = {2006},
date = {2006-06-26},
journal = {AIDS (London, England)},
volume = {20},
number = {10},
pages = {1391-9},
abstract = {OBJECTIVES:
To evaluate virologic response up to 48 weeks, and emergence of HIV-1 resistance mutations at 24 weeks, in therapy-naive adults initiating zidovudine/lamivudine/tenofovir DF.
DESIGN:
: A cohort within the DART trial.
METHODS:
Plasma HIV-1 RNA was assayed in 300 adults with baseline CD4 cell count < 200 cells/mul from sites in Uganda and Zimbabwe using the Roche Amplicor assay v1.5. Samples with HIV-1 RNA > 1000 copies/ml at 24 weeks were sequenced in the pol region.
RESULTS:
Median baseline CD4 cell count was 101 cells/mul and HIV-1 RNA 279,910 copies/ml (mean, 5.4 log10). At 48 weeks, 61% (165/272) had HIV-1 RNA < 50 and 72% (196/272) < 400 copies/ml, compared with 59% (167/281) and 79% (221/281) at 24 weeks. At 24 and 48 weeks, 15 and 24% respectively had HIV-1 RNA > 1000 copies/ml (6 and 17% > 10 000 copies/ml), and mean CD4 cell count increases were 103 and 127 cells/mul, respectively. Higher baseline CD4 cell count was the most important predictor of virological suppression at 48 weeks, with little effect of baseline viral load. Eighteen of 20 genotypes from week 24 samples with HIV-1 RNA > 1000 copies/ml showed key resistance mutations in reverse transcriptase. Fourteen had M184V [10 with one to four additional nucleoside analogue mutations (NAMs)]; one had three NAMs only; and the remaining three had K65R. One participant with M184V had major non-nucleoside reverse transcriptase inhibitor-associated mutations, despite no disclosed treatment with this class.
CONCLUSION:
Zidovudine/lamivudine/tenofovir has good virological efficacy in advanced HIV disease. In this population, who were infected with HIV-1 subtypes A, C or D, M184V with or without NAMs was the most common route to resistance, whereas K65R was identified less often.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES:
To evaluate virologic response up to 48 weeks, and emergence of HIV-1 resistance mutations at 24 weeks, in therapy-naive adults initiating zidovudine/lamivudine/tenofovir DF.
DESIGN:
: A cohort within the DART trial.
METHODS:
Plasma HIV-1 RNA was assayed in 300 adults with baseline CD4 cell count < 200 cells/mul from sites in Uganda and Zimbabwe using the Roche Amplicor assay v1.5. Samples with HIV-1 RNA > 1000 copies/ml at 24 weeks were sequenced in the pol region.
RESULTS:
Median baseline CD4 cell count was 101 cells/mul and HIV-1 RNA 279,910 copies/ml (mean, 5.4 log10). At 48 weeks, 61% (165/272) had HIV-1 RNA < 50 and 72% (196/272) < 400 copies/ml, compared with 59% (167/281) and 79% (221/281) at 24 weeks. At 24 and 48 weeks, 15 and 24% respectively had HIV-1 RNA > 1000 copies/ml (6 and 17% > 10 000 copies/ml), and mean CD4 cell count increases were 103 and 127 cells/mul, respectively. Higher baseline CD4 cell count was the most important predictor of virological suppression at 48 weeks, with little effect of baseline viral load. Eighteen of 20 genotypes from week 24 samples with HIV-1 RNA > 1000 copies/ml showed key resistance mutations in reverse transcriptase. Fourteen had M184V [10 with one to four additional nucleoside analogue mutations (NAMs)]; one had three NAMs only; and the remaining three had K65R. One participant with M184V had major non-nucleoside reverse transcriptase inhibitor-associated mutations, despite no disclosed treatment with this class.
CONCLUSION:
Zidovudine/lamivudine/tenofovir has good virological efficacy in advanced HIV disease. In this population, who were infected with HIV-1 subtypes A, C or D, M184V with or without NAMs was the most common route to resistance, whereas K65R was identified less often. |
John, Laurence; Kambugu, Andrew; Songa, Patricia; castelnouvo, Barbara; Colebunders, Robert; Kamya, Moses Are the best antiretrovirals being used in Africa? Journal Article In: Journal of HIV Therapy, vol. 11, no. 1, pp. 11-5, 2006. @article{John2006,
title = {Are the best antiretrovirals being used in Africa?},
author = { Laurence John and Andrew Kambugu and Patricia Songa and Barbara castelnouvo and Robert Colebunders and Moses Kamya },
year = {2006},
date = {2006-03-01},
journal = {Journal of HIV Therapy},
volume = {11},
number = {1},
pages = {11-5},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Colebunders, R.; Ronald, A.; Katabira, E.; Sande, M. How Can Earlier Entry of Patients into Antiretroviral Programs in Low-Income Countries Be Promoted? Reply to Lawn and Wood Journal Article In: Clinical Infectious Diseases, vol. 42, no. 3, pp. 432-433, 2006. @article{Colebunders2006b,
title = {How Can Earlier Entry of Patients into Antiretroviral Programs in Low-Income Countries Be Promoted? Reply to Lawn and Wood},
author = {R. Colebunders and A. Ronald and E. Katabira and M. Sande },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Reply-to-Lawn-and-Wood..pdf},
doi = {10.1086/499525},
year = {2006},
date = {2006-02-01},
journal = {Clinical Infectious Diseases},
volume = {42},
number = {3},
pages = {432-433},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Colebunders, Robert; Kamya, R Moses; Laurence, John; Shihab, Hasan M; Semitala, Fred; Lutwama, Fred; Bakeera-Kitaka, Sabrina; Lynen, Lut; Spacek, Lisa; Reynolds, Steven J; Quinn, Thomas C; Brant; Mayanja-Kizza Viner, Harriet A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor Countries Journal Article In: Lancet Infectious Diseases, vol. 6, no. 1, pp. 53-9, 2006. @article{Colebunders2006,
title = {A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor Countries},
author = {Colebunders, Robert and Kamya, R Moses and Laurence, John and Shihab, Hasan M and Semitala, Fred and Lutwama, Fred and Bakeera-Kitaka, Sabrina and Lynen, Lut and Spacek, Lisa and Reynolds, Steven J and Quinn, Thomas C and Viner, Brant; Mayanja-Kizza, Harriet},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/A-new-model-to-monitor-the-virological-efficacy-of-antiretroviral-treatment-in-resource-poor-countries..pdf},
doi = {DOI: 10.1016/S1473-3099(05)70327-3},
year = {2006},
date = {2006-01-15},
journal = {Lancet Infectious Diseases},
volume = {6},
number = {1},
pages = {53-9},
abstract = {Monitoring the efficacy of antiretroviral treatment in developing countries is difficult because these countries have few laboratory facilities to test viral load and drug resistance. Those that exist are faced with a shortage of trained staff, unreliable electricity supply, and costly reagents. Not only that, but most HIV patients in resource-poor countries do not have access to such testing. We propose a new model for monitoring antiretroviral treatment in resource-limited settings that uses patients' clinical and treatment history, adherence to treatment, and laboratory indices such as haemoglobin level and total lymphocyte count to identify virological treatment failure, and offers patients future treatment options. We believe that this model can make an accurate diagnosis of treatment failure in most patients. However, operational research is needed to assess whether this strategy works in practice.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Monitoring the efficacy of antiretroviral treatment in developing countries is difficult because these countries have few laboratory facilities to test viral load and drug resistance. Those that exist are faced with a shortage of trained staff, unreliable electricity supply, and costly reagents. Not only that, but most HIV patients in resource-poor countries do not have access to such testing. We propose a new model for monitoring antiretroviral treatment in resource-limited settings that uses patients' clinical and treatment history, adherence to treatment, and laboratory indices such as haemoglobin level and total lymphocyte count to identify virological treatment failure, and offers patients future treatment options. We believe that this model can make an accurate diagnosis of treatment failure in most patients. However, operational research is needed to assess whether this strategy works in practice. |
Spacek, L. A.; Shihab, H. M.; M. R.; Mwesigire Kamya, D.; Ronald, A.; Mayanja, H.; Moore, R. D.; Bates, M.; Quinn, T. C. Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda. Journal Article In: Clinical Infectious Diseases, vol. 42, no. 2, pp. 252-9, 2006. @article{Spacek2006,
title = {Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda.},
author = {Spacek, L. A. and Shihab, H. M. and Kamya, M. R.; Mwesigire, D. and Ronald, A. and Mayanja, H. and Moore, R. D. and Bates, M. and Quinn, T. C.},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/08/Response-to-antiretroviral-therapy-in-HIV-infected-patients-attending-a-public-urban-clinic-in-Kampala-Uganda..pdf},
doi = {10.1086/499044},
year = {2006},
date = {2006-01-15},
journal = {Clinical Infectious Diseases},
volume = {42},
number = {2},
pages = {252-9},
abstract = {BACKGROUND:
Access to antiretroviral therapy and human immunodeficiency virus (HIV) care is increasing in resource-limited settings. We evaluated clinical, behavioral, and demographic risk factors associated with virologic suppression in a public, urban clinic in Kampala, Uganda.
METHODS:
We conducted a cross-sectional, observational study of 137 HIV-infected patients who were receiving antiretroviral therapy at the infectious diseases clinic at Mulago Hospital (Kampala). We measured the prevalence of viral suppression, evaluated risk factors associated with virologic failure, and documented phenotypic resistance patterns and genotypic mutations.
RESULTS:
A total of 91 (66%) of 137 participants had an undetectable viral load (< 400 copies/mL) after a median duration of 38 weeks (interquartile range, 24-62 weeks) of antiretroviral therapy. Median CD4 cell count was 163 cells/mm3 (interquartile range, 95-260 cells/mm3). The majority of the patients (91%) were treated with nonnucleoside reverse-transcriptase inhibitor-based 3-drug regimens. In multivariate analysis, treatment with the first antiretroviral regimen was associated with viral suppression (odds ratio, 2.6; 95% confidence interval, 1.1-6.1). In contrast, a history of unplanned treatment interruption was associated with virologic treatment failure (odds ratio, 0.2; 95% confidence interval, 0.1-0.6). Of 124 participants treated with nonnucleoside reverse-transcriptase inhibitors, 27 (22%) were documented to have experienced virologic treatment failure. The most common mutation detected was K103N (found in 14 of 27 patients with virologic treatment failure).
CONCLUSIONS:
Although many HIV-infected people treated in Kampala, Uganda, have advanced HIV disease, the majority of patients who received antiretroviral therapy experienced viral suppression and clinical benefit. Because of the frequent use of nonnucleoside reverse-transcriptase inhibitor-based therapy, the majority of resistance was against this drug class. In resource-limited settings, initiation of therapy with a potent, durable regimen, accompanied by stable drug supplies, will optimize the likelihood of viral suppression.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
Access to antiretroviral therapy and human immunodeficiency virus (HIV) care is increasing in resource-limited settings. We evaluated clinical, behavioral, and demographic risk factors associated with virologic suppression in a public, urban clinic in Kampala, Uganda.
METHODS:
We conducted a cross-sectional, observational study of 137 HIV-infected patients who were receiving antiretroviral therapy at the infectious diseases clinic at Mulago Hospital (Kampala). We measured the prevalence of viral suppression, evaluated risk factors associated with virologic failure, and documented phenotypic resistance patterns and genotypic mutations.
RESULTS:
A total of 91 (66%) of 137 participants had an undetectable viral load (< 400 copies/mL) after a median duration of 38 weeks (interquartile range, 24-62 weeks) of antiretroviral therapy. Median CD4 cell count was 163 cells/mm3 (interquartile range, 95-260 cells/mm3). The majority of the patients (91%) were treated with nonnucleoside reverse-transcriptase inhibitor-based 3-drug regimens. In multivariate analysis, treatment with the first antiretroviral regimen was associated with viral suppression (odds ratio, 2.6; 95% confidence interval, 1.1-6.1). In contrast, a history of unplanned treatment interruption was associated with virologic treatment failure (odds ratio, 0.2; 95% confidence interval, 0.1-0.6). Of 124 participants treated with nonnucleoside reverse-transcriptase inhibitors, 27 (22%) were documented to have experienced virologic treatment failure. The most common mutation detected was K103N (found in 14 of 27 patients with virologic treatment failure).
CONCLUSIONS:
Although many HIV-infected people treated in Kampala, Uganda, have advanced HIV disease, the majority of patients who received antiretroviral therapy experienced viral suppression and clinical benefit. Because of the frequent use of nonnucleoside reverse-transcriptase inhibitor-based therapy, the majority of resistance was against this drug class. In resource-limited settings, initiation of therapy with a potent, durable regimen, accompanied by stable drug supplies, will optimize the likelihood of viral suppression. |
Van den Bergh, R; Vanham, G.; Raes, G.; De Baetselier, P.; Colebunders, R. Mycobacterium-associated immune reconstitution disease: macrophages running wild? Journal Article In: The Lancet Infectious Diseases, vol. 6, no. 1, pp. 2-3, 2006. @article{denBergh2006,
title = {Mycobacterium-associated immune reconstitution disease: macrophages running wild?},
author = {Van den Bergh, R and Vanham, G. and Raes, G. and De Baetselier, P. and Colebunders, R.},
doi = {10.1016/S1473-3099(05)70302-9},
year = {2006},
date = {2006-01-01},
journal = { The Lancet Infectious Diseases},
volume = {6},
number = {1},
pages = {2-3},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
2005
|
Apers, L.; Lynen, L.; Worodria, W.; Colebunders, R. Review editorial: prevention of tuberculosis in resource-poor countries with increasing access to highly active antiretroviral treatment Journal Article In: Tropical Medicine & International Health, vol. 10, no. 12, pp. 1209-14, 2005. @article{Apers2005,
title = {Review editorial: prevention of tuberculosis in resource-poor countries with increasing access to highly active antiretroviral treatment},
author = {Apers, L. and Lynen, L. and Worodria, W. and Colebunders, R.},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Review-editorial-Prevention-of-tuberculosis-in-resource-poor-countries-with-increasing-access-to-highly-active-antiretroviral-treatment.pdf},
doi = {https://doi.org/10.1111/j.1365-3156.2005.01516.x},
year = {2005},
date = {2005-12-01},
journal = {Tropical Medicine & International Health},
volume = {10},
number = {12},
pages = {1209-14},
abstract = {The administration of isoniazid (INH) has been proposed, evaluated and implemented to prevent tuberculosis (TB) disease among patients who are infected with the human immunodeficiency virus (HIV). This strategy has been developed in communities where TB is highly endemic and at a time when antiretroviral (ARV) treatment was not, or was rarely available. Although INH prevention programmes were somewhat pushed to the background due to the worldwide advocacy for ARV drugs, prevention of TB remains of paramount importance. The dual HIV-TB infection poses problems, not only for the individual and his/her clinician but also for the programme manager. We review various aspects of TB preventive treatment in countries with a high prevalence of HIV-TB co-infection and limited resources but with increasing access to ARV treatment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The administration of isoniazid (INH) has been proposed, evaluated and implemented to prevent tuberculosis (TB) disease among patients who are infected with the human immunodeficiency virus (HIV). This strategy has been developed in communities where TB is highly endemic and at a time when antiretroviral (ARV) treatment was not, or was rarely available. Although INH prevention programmes were somewhat pushed to the background due to the worldwide advocacy for ARV drugs, prevention of TB remains of paramount importance. The dual HIV-TB infection poses problems, not only for the individual and his/her clinician but also for the programme manager. We review various aspects of TB preventive treatment in countries with a high prevalence of HIV-TB co-infection and limited resources but with increasing access to ARV treatment. |
John, L.; Baalwa, J.; Kalimugogo, P.; Nabankema, E.; Castelnuovo, B.; Muhindo, G.; R, Colebunders; Kambugu, A. Response to 'Does immune reconstitution promote active tuberculosis in patients receiving highly active antiretroviral therapy? AIDS, 22 July 2005. Journal Article In: AIDS (London, England), vol. 19, no. 17, pp. 2049-50, 2005. @article{John2005,
title = {Response to 'Does immune reconstitution promote active tuberculosis in patients receiving highly active antiretroviral therapy? AIDS, 22 July 2005.},
author = {L. John and J. Baalwa and P. Kalimugogo and E. Nabankema and B. Castelnuovo and G. Muhindo and R, Colebunders and A. Kambugu },
year = {2005},
date = {2005-11-18},
journal = {AIDS (London, England)},
volume = {19},
number = {17},
pages = {2049-50},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Sacktor, N. C.; Wong, M.; Nakasujja, N.; Skolasky, R. L.; Selnes, O. A.; Musisi, S.; Robertson, K.; McArthur, J. C.; Ronald, A.; Katabira, E. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. Journal Article In: AIDS (London, England), vol. 19, no. 13, pp. 1367-74, 2005. @article{Sacktor2005,
title = {The International HIV Dementia Scale: a new rapid screening test for HIV dementia.},
author = {Sacktor, N. C. and Wong, M. and Nakasujja, N. and Skolasky, R. L. and Selnes, O. A. and Musisi, S. and Robertson, K. and McArthur, J. C. and Ronald, A. and Katabira, E.},
doi = {DOI: 10.1097/01.aids.0000180790.77379.3a},
year = {2005},
date = {2005-09-02},
journal = {AIDS (London, England)},
volume = {19},
number = {13},
pages = {1367-74},
abstract = {Abstract
OBJECTIVE:
HIV dementia is an important neurological complication of advanced HIV infection. The use of a cross-cultural screening test to detect HIV dementia within the international community is critical for diagnosing this condition. The objective of this study was to evaluate the sensitivity and specificity of a new screening test for HIV dementia, the International HIV Dementia Scale (IHDS) in cohorts from the US and Uganda.
DESIGN:
Two cross-sectional cohort studies designed to evaluate for the presence of HIV dementia.
METHODS:
Sixty-six HIV-positive individuals in the US and 81 HIV-positive individuals in Uganda received the IHDS and full standardized neurological and neuropsychological assessments. The sensitivity and specificity of varying cut-off scores of the IHDS were evaluated in the two cohorts.
RESULTS:
In the US cohort, the mean IHDS score for HIV-positive individuals without dementia and with dementia were 10.6 and 9.3 respectively (P < 0.001). Using the cut-off of < or = 10, the sensitivity and specificity for HIV dementia with the IHDS were 80% and 57% respectively in the US cohort, and 80% and 55% respectively in the Uganda cohort.
CONCLUSIONS:
The IHDS may be a useful screening test to identify individuals at risk for HIV dementia in both the industrialized world and the developing world. Full neuropsychological testing should then be performed to confirm a diagnosis of HIV dementia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
OBJECTIVE:
HIV dementia is an important neurological complication of advanced HIV infection. The use of a cross-cultural screening test to detect HIV dementia within the international community is critical for diagnosing this condition. The objective of this study was to evaluate the sensitivity and specificity of a new screening test for HIV dementia, the International HIV Dementia Scale (IHDS) in cohorts from the US and Uganda.
DESIGN:
Two cross-sectional cohort studies designed to evaluate for the presence of HIV dementia.
METHODS:
Sixty-six HIV-positive individuals in the US and 81 HIV-positive individuals in Uganda received the IHDS and full standardized neurological and neuropsychological assessments. The sensitivity and specificity of varying cut-off scores of the IHDS were evaluated in the two cohorts.
RESULTS:
In the US cohort, the mean IHDS score for HIV-positive individuals without dementia and with dementia were 10.6 and 9.3 respectively (P < 0.001). Using the cut-off of < or = 10, the sensitivity and specificity for HIV dementia with the IHDS were 80% and 57% respectively in the US cohort, and 80% and 55% respectively in the Uganda cohort.
CONCLUSIONS:
The IHDS may be a useful screening test to identify individuals at risk for HIV dementia in both the industrialized world and the developing world. Full neuropsychological testing should then be performed to confirm a diagnosis of HIV dementia. |
Colebunders, R.; John, L.; Muganzi, A.; Lynen, L.; Kambugu, A. Palliative care in sub-Saharan Africa Journal Article In: Lancet (London, England), vol. 366, no. 9485, pp. 546-7, 2005. @article{Colebunders2005b,
title = {Palliative care in sub-Saharan Africa},
author = {Colebunders, R. and John, L. and Muganzi, A. and Lynen, L. and Kambugu, A.},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Palliative-care-in-sub-Saharan-Africa.pdf},
doi = {DOI: 10.1016/S0140-6736(05)67094-8},
year = {2005},
date = {2005-08-13},
journal = {Lancet (London, England)},
volume = {366},
number = {9485},
pages = {546-7},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Colebunders, R.; Kamya, M. R.; Laurence, J.; Kambugu, A.; Byakwaga, H.; Mwebaze, P. S.; A., M. Muganga.; Katwere, M.; Katabira, E. First-line antiretroviral therapy in Africa--how evidence-base are our recommendations? Journal Article In: AIDS, reviews, vol. 7, no. 3, pp. 148-54, 2005. @article{Colebunders2005,
title = {First-line antiretroviral therapy in Africa--how evidence-base are our recommendations?},
author = {Colebunders, R. and Kamya, M. R. and Laurence, J. and Kambugu, A. and Byakwaga, H. and Mwebaze, P. S. and M. Muganga. A. and Katwere, M. and Katabira, E.},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/First-line-antiretroviral-therapy-in-Africa-how-evidence-base-are-our-recommendations.pdf},
year = {2005},
date = {2005-07-31},
journal = {AIDS, reviews},
volume = {7},
number = {3},
pages = {148-54},
abstract = {According to the World Health Organization guidelines, a non-nucleoside reverse transcriptase inhibitor (NNRTI) along with two nucleoside reverse transcriptase inhibitors (NRTI) is the treatment of choice as first-line antiretroviral therapy. The results of the 2NN and different cohort studies performed in developed countries do not provide sufficient evidence by which to select between nevirapine and efavirenz as the first-line NNRTI for antiretroviral therapy in Africa. The current first-line NNRTI-containing antiretroviral therapy regimens used in Africa are certainly not ideal. Nevirapine interacts with rifampicin and therefore is not indicated in patients with tuberculosis. On the other hand, efavirenz should not be given to pregnant women. NNRTI-containing regimens may be less effective in women who received nevirapine monotherapy at delivery. Stavudine, used in the nucleoside backbone, may lead to lipoatrophy, lactic acidosis and polyneuritis. Zidovudine may cause serious anemia. Mainly because of cost considerations, the generic fixed-drug combination of nevirapine plus two NRTI seems at the moment to be the best choice. It is clear, however, that antiretroviral programs should not rely only on this combination for initial antiretroviral treatment. Most importantly, more HIV clinical trials need to be conducted in Africa, and African cohorts of patients on antiretroviral therapy need to be established in order to develop recommendations that are evidence based.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
According to the World Health Organization guidelines, a non-nucleoside reverse transcriptase inhibitor (NNRTI) along with two nucleoside reverse transcriptase inhibitors (NRTI) is the treatment of choice as first-line antiretroviral therapy. The results of the 2NN and different cohort studies performed in developed countries do not provide sufficient evidence by which to select between nevirapine and efavirenz as the first-line NNRTI for antiretroviral therapy in Africa. The current first-line NNRTI-containing antiretroviral therapy regimens used in Africa are certainly not ideal. Nevirapine interacts with rifampicin and therefore is not indicated in patients with tuberculosis. On the other hand, efavirenz should not be given to pregnant women. NNRTI-containing regimens may be less effective in women who received nevirapine monotherapy at delivery. Stavudine, used in the nucleoside backbone, may lead to lipoatrophy, lactic acidosis and polyneuritis. Zidovudine may cause serious anemia. Mainly because of cost considerations, the generic fixed-drug combination of nevirapine plus two NRTI seems at the moment to be the best choice. It is clear, however, that antiretroviral programs should not rely only on this combination for initial antiretroviral treatment. Most importantly, more HIV clinical trials need to be conducted in Africa, and African cohorts of patients on antiretroviral therapy need to be established in order to develop recommendations that are evidence based. |
Sande, M.; Ronald, A. HIV/AIDS care in Africa today Journal Article In: Clinical Infectious Diseases, vol. 40, no. 7, pp. 1045-8, 2005. @article{Sande2005,
title = {HIV/AIDS care in Africa today},
author = {Sande, M. and Ronald, A.},
doi = {DOI: 10.1086/428360},
year = {2005},
date = {2005-04-01},
journal = {Clinical Infectious Diseases},
volume = {40},
number = {7},
pages = {1045-8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Ryan, M.; Tchum, I.; Coakley, P.; Merry, C. Healthcare worker crisis in Africa jeopardises the fight against HIV/AIDS Journal Article In: Irish Medical Journal, vol. 98, no. 2, pp. 61, 2005. @article{Ryan2005,
title = {Healthcare worker crisis in Africa jeopardises the fight against HIV/AIDS},
author = {Ryan, M. and Tchum, I. and Coakley, P. and Merry, C.},
year = {2005},
date = {2005-02-01},
journal = {Irish Medical Journal},
volume = {98},
number = {2},
pages = {61},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Feld, Jordan. J.; Ocama, Ponsiano; Ronald, Allan. The liver in HIV in Africa Journal Article In: Ativiral Therapy, vol. 10, no. 8, pp. 953-965, 2005. @article{Feld2005,
title = {The liver in HIV in Africa},
author = {Feld, Jordan. J. and Ocama, Ponsiano and Ronald, Allan.},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/The-liver-in-HIV-in-Africa.pdf},
year = {2005},
date = {2005-01-01},
journal = {Ativiral Therapy},
volume = {10},
number = {8},
pages = {953-965},
abstract = {As access to antiretroviral therapy improves across the African continent, liver disease is emerging as an important cause of morbidity and mortality among HIV-infected individuals. Although coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV), along with highly active antiretroviral therapy (HAART)-induced hepatotoxicity appear to be the major causes of liver disease in this population, other diseases endemic to Africa with hepatic manifestations are influenced by HIV infection as well. In this review we present the available data on liver disease in HIV-infected populations in Africa and discuss relevant data from the rest of the world. In addition, we highlight important areas for further study.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
As access to antiretroviral therapy improves across the African continent, liver disease is emerging as an important cause of morbidity and mortality among HIV-infected individuals. Although coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV), along with highly active antiretroviral therapy (HAART)-induced hepatotoxicity appear to be the major causes of liver disease in this population, other diseases endemic to Africa with hepatic manifestations are influenced by HIV infection as well. In this review we present the available data on liver disease in HIV-infected populations in Africa and discuss relevant data from the rest of the world. In addition, we highlight important areas for further study. |
Byakika-Tusiime, J.; Oyugi, J. H.; Tumwikirize, W. A.; Katabira, E. T.; Mugyenyi, P. N.; Bangsberg, D. R. Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy Journal Article In: International Journal of STD & AIDS, vol. 16, no. 1, pp. 38, 2005. @article{Byakika-Tusiime2005,
title = {Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy},
author = {Byakika-Tusiime, J. and Oyugi, J. H. and Tumwikirize, W. A. and Katabira, E. T. and Mugyenyi, P. N. and Bangsberg, D. R.},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Adherence-to-HIV-antiretroviral-therapy-in-HIV-Ugandan-patients-purchasing-therapy.pdf},
year = {2005},
date = {2005-01-01},
journal = {International Journal of STD & AIDS},
volume = {16},
number = {1},
pages = {38},
abstract = {Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at ±95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32–6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64–4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at ±95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32–6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64–4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence. |
2004
|
Wabinga, HR; Colebunders, B; Odida, M; Ocama, P; Colebunders, R Risk Risk factors for and types of oesophageal cancer. Journal Article In: Lancet, (London, England)., vol. 364, no. 9450, pp. 2018, 2004. @article{Wabinga2004,
title = {Risk Risk factors for and types of oesophageal cancer.},
author = {HR Wabinga and B Colebunders and M Odida and P Ocama and R Colebunders},
doi = {10.1016/S0140-6736(04)17508-9},
year = {2004},
date = {2004-12-04},
journal = {Lancet, (London, England).},
volume = {364},
number = {9450},
pages = {2018},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Resneck, JS Jr.; M., Van Beek; Furmanski, L.; J., Oyugi; LeBoit, PE.; Katabira, E.; Kambugu, F.; Maurer, T.; Berger, T.; Pletcher, MJ.; Machtinger, EL. Etiology of pruritic papular eruption with HIV infection in Uganda. Journal Article In: JAMA, vol. 292, no. 21, pp. 2614-21, 2004. @article{Resneck2004,
title = {Etiology of pruritic papular eruption with HIV infection in Uganda.},
author = {Resneck, JS Jr. and Van Beek M. and Furmanski, L. and Oyugi J. and LeBoit, PE. and Katabira, E. and Kambugu, F. and Maurer, T. and Berger, T. and Pletcher, MJ. and Machtinger, EL.},
year = {2004},
date = {2004-12-01},
journal = {JAMA},
volume = {292},
number = {21},
pages = {2614-21},
abstract = {CONTEXT:
A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive.
OBJECTIVE:
To determine the etiology of PPE occurring in HIV-infected individuals.
DESIGN, SETTING, AND PATIENTS:
Cross-sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist.
MAIN OUTCOME MEASURES:
Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity.
RESULTS:
Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/microL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/microL; P = .02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/microL; P = .07) than those without histological evidence of arthropod bites.
CONCLUSIONS:
Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
CONTEXT:
A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive.
OBJECTIVE:
To determine the etiology of PPE occurring in HIV-infected individuals.
DESIGN, SETTING, AND PATIENTS:
Cross-sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist.
MAIN OUTCOME MEASURES:
Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity.
RESULTS:
Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/microL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/microL; P = .02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/microL; P = .07) than those without histological evidence of arthropod bites.
CONCLUSIONS:
Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients. |
Oyugi, JH.; Byakika-Tusiime, J.; Charlebois, ED.; Kityo, C.; Mugerwa, R.; Mugyenyi, P.; Bangsberg, DR Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting Journal Article In: Journal of Acquired Immune Deficiency Syndrome (1999), vol. 36, no. 5, pp. 1100-2, 2004. @article{Oyugi2004,
title = {Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting},
author = {Oyugi, JH. and Byakika-Tusiime, J. and Charlebois, ED. and Kityo, C. and Mugerwa, R. and Mugyenyi, P. and Bangsberg, DR},
year = {2004},
date = {2004-08-15},
journal = {Journal of Acquired Immune Deficiency Syndrome (1999)},
volume = {36},
number = {5},
pages = {1100-2},
abstract = {BACKGROUND:
There are no validated measures of adherence to HIV antiretroviral therapy in resource-poor settings. Such measures are essential to understand the unique barriers to adherence as access to HIV antiretroviral therapy expands.
METHODS:
We assessed correspondence between multiple measures of adherence and viral load suppression in 34 patients purchasing generic Triomune antiretroviral therapy (coformulated stavudine, lamivudine, and nevirapine; CIPLA, Ltd., Mumbai, India) in Kampala, Uganda. Measures included 3-day patient self-report, 30-day visual analog scale, electronic medication monitoring, and unannounced home pill count. HIV-1 load was determined at baseline and 12 weeks.
RESULTS:
Mean adherence was 91%-94% by all measures. Seventy-six percent of subjects had a viral load of <400 copies/mL at 12 weeks. All measures were closely correlated with each other (R = 0.77-0.89). Each measure was also significantly associated with 12-week HIV load. There was no significant difference between patient-reported and objective measures of adherence.
CONCLUSIONS:
This sample of patients purchasing generic HIV antiretroviral therapy has among the highest measured adherence reported to date. Patient-reported measures were closely associated with objective measures. The relative ease of administration of the 30-day visual analog scale suggests that this may be the preferred method to assess adherence in resource-poor settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
There are no validated measures of adherence to HIV antiretroviral therapy in resource-poor settings. Such measures are essential to understand the unique barriers to adherence as access to HIV antiretroviral therapy expands.
METHODS:
We assessed correspondence between multiple measures of adherence and viral load suppression in 34 patients purchasing generic Triomune antiretroviral therapy (coformulated stavudine, lamivudine, and nevirapine; CIPLA, Ltd., Mumbai, India) in Kampala, Uganda. Measures included 3-day patient self-report, 30-day visual analog scale, electronic medication monitoring, and unannounced home pill count. HIV-1 load was determined at baseline and 12 weeks.
RESULTS:
Mean adherence was 91%-94% by all measures. Seventy-six percent of subjects had a viral load of <400 copies/mL at 12 weeks. All measures were closely correlated with each other (R = 0.77-0.89). Each measure was also significantly associated with 12-week HIV load. There was no significant difference between patient-reported and objective measures of adherence.
CONCLUSIONS:
This sample of patients purchasing generic HIV antiretroviral therapy has among the highest measured adherence reported to date. Patient-reported measures were closely associated with objective measures. The relative ease of administration of the 30-day visual analog scale suggests that this may be the preferred method to assess adherence in resource-poor settings. |
Sande, MA.; A., Ronald Treatment of HIV/AIDS: do the dilemmas only increase? Journal Article In: JAMA, vol. 292, no. 2, pp. 266-8, 2004. @article{Sande2004,
title = {Treatment of HIV/AIDS: do the dilemmas only increase?},
author = {Sande, MA. and Ronald A.},
doi = {10.1001/jama.292.2.266},
year = {2004},
date = {2004-07-14},
journal = {JAMA},
volume = {292},
number = {2},
pages = {266-8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
1998
|
Shank, Gary The extraordinary ordinary powers of abductive reasoning Journal Article In: Theory & Psychology, vol. 8, no. 6, pp. 841–860, 1998. @article{shank1998extraordinary,
title = {The extraordinary ordinary powers of abductive reasoning},
author = {Gary Shank},
year = {1998},
date = {1998-01-01},
journal = {Theory & Psychology},
volume = {8},
number = {6},
pages = {841--860},
publisher = {Sage Publications Sage CA: Thousand Oaks, CA},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
1993
|
Paul, Gabriele Approaches to abductive reasoning: an overview Journal Article In: Artificial intelligence review, vol. 7, no. 2, pp. 109–152, 1993. @article{paul1993approaches,
title = {Approaches to abductive reasoning: an overview},
author = {Gabriele Paul},
year = {1993},
date = {1993-01-01},
journal = {Artificial intelligence review},
volume = {7},
number = {2},
pages = {109--152},
publisher = {Springer},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
0000
|
Fiona Cresswell Eva Laker Agnes Odongpiny, Arnold Arinaitwe High willingness to use injectable antiretroviral therapy among women who have been lost to follow-up from HIV programmes: A nested cross-sectional study. Journal Article In: HIV Medicine, vol. 23, no. 4, pp. 319-323, 0000. @article{Odongpiny2022,
title = {High willingness to use injectable antiretroviral therapy among women who have been lost to follow-up from HIV programmes: A nested cross-sectional study.},
author = {Eva Laker Agnes Odongpiny, Fiona Cresswell, Arnold Arinaitwe, Vivian Nakate, Joshua Kyenkya, Mohammed Lamorde, Catriona Waitt, David Meya, Agnes Kiragga},
doi = {https://doi.org/10.1111/hiv.13260},
journal = {HIV Medicine},
volume = {23},
number = {4},
pages = {319-323},
abstract = {Objectives
Efforts to achieve zero transmission of HIV to infants born to women living with HIV in sub-Saharan African are undermined by high rates of loss to follow-up in prevention of vertical transmission (PVT) programmes. The fear of HIV status disclosure through the discovery of pill bottles at home is a major contributor. Injectable antiretroviral therapy (ART) has proved to be efficacious in clinical trials and is discreet, offering a potential solution. We investigated the knowledge and willingness to use injectable ART among women who were lost to follow-up from the PVT programme in Uganda.
Methods
Women were traced by nurse counsellors and knowledge and opinions relating to injectable ART, including willingness to use it when it becomes available, were collected. Generalized linear models were used to determine predictors of willingness to use injectable ART.
Conclusions
Among 1023 women registered between 2017 and 2019 under the PVT programmes in Kampala and Wakiso districts, Uganda, 385 (38%) were lost to follow-up from care and 22% of these (83/385) were successfully traced and interviewed. Only 25% (21/83) had heard of injectable ART. Over half (55%, 46/83) were very willing to use injectable ART, 40% (33/83) were somewhat willing and four (5%) were not willing. Those who associated ART tablets with disclosure risk were more willing to consider injectable ART (adjusted odds ratio = 4.21; 95% confidence interval: 1.45–12.19; p = 0.008).
We report high willingness to use injectable ART associated with fears that ART tablets were a potential source of HIV status disclosure. Injectable ART could be a solution for women who have challenges with disclosure.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objectives
Efforts to achieve zero transmission of HIV to infants born to women living with HIV in sub-Saharan African are undermined by high rates of loss to follow-up in prevention of vertical transmission (PVT) programmes. The fear of HIV status disclosure through the discovery of pill bottles at home is a major contributor. Injectable antiretroviral therapy (ART) has proved to be efficacious in clinical trials and is discreet, offering a potential solution. We investigated the knowledge and willingness to use injectable ART among women who were lost to follow-up from the PVT programme in Uganda.
Methods
Women were traced by nurse counsellors and knowledge and opinions relating to injectable ART, including willingness to use it when it becomes available, were collected. Generalized linear models were used to determine predictors of willingness to use injectable ART.
Conclusions
Among 1023 women registered between 2017 and 2019 under the PVT programmes in Kampala and Wakiso districts, Uganda, 385 (38%) were lost to follow-up from care and 22% of these (83/385) were successfully traced and interviewed. Only 25% (21/83) had heard of injectable ART. Over half (55%, 46/83) were very willing to use injectable ART, 40% (33/83) were somewhat willing and four (5%) were not willing. Those who associated ART tablets with disclosure risk were more willing to consider injectable ART (adjusted odds ratio = 4.21; 95% confidence interval: 1.45–12.19; p = 0.008).
We report high willingness to use injectable ART associated with fears that ART tablets were a potential source of HIV status disclosure. Injectable ART could be a solution for women who have challenges with disclosure.
|
Ocama, P.; Castelnuovo, B.; Kamya, M. R.; Kirk, G. D; Reynolds, S. J.; Kiragga, A.; Colebunders, R.; Thomas, D. L. Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda. Journal Article In: International Journal of STD & AIDS, vol. 21, no. 8, pp. 553-7, 0000. @article{Ocama2010c,
title = {Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda.},
author = {P. Ocama and B. Castelnuovo and M.R. Kamya and G.D Kirk and S.J. Reynolds and A. Kiragga and R. Colebunders and D. L. Thomas},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/09/Low-frequency-of-liver-enzyme-elevation-in-HIV-infected-patients-attending-a-large-urban-treatment-centre-in-Uganda..pdf},
doi = {10.1258/ijsa.2010.010027.},
journal = {International Journal of STD & AIDS},
volume = {21},
number = {8},
pages = {553-7},
abstract = {Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20-164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20-164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting. |
Seremba, E.; Ocama, P.; Opio, CK.; Kagimu, M.; Thomas, DL.; Yuan, HJ.; Attar, N.; Lee, WM Poor performance of hepatitis C antibody tests in hospital patients in Uganda. Journal Article In: Journal of Medical Virology, vol. 82, no. 8, pp. 1371-8, 0000. @article{Seremba2010,
title = {Poor performance of hepatitis C antibody tests in hospital patients in Uganda.},
author = {Seremba, E. and Ocama, P. and Opio, CK. and Kagimu, M. and Thomas, DL. and Yuan, HJ. and Attar, N. and Lee, WM},
doi = {10.1002/jmv.21817.},
journal = {Journal of Medical Virology},
volume = {82},
number = {8},
pages = {1371-8},
abstract = {Most hepatitis C testing in Uganda is performed using commercial rapid strip assays (RSA) to detect antibodies to hepatitis C virus (anti‐HCV), rather than enzyme immunoassays (EIA). The prevalence of hepatitis C antibodies in a Ugandan hospital population was determined using both methods to test their accuracy using nucleic acid testing (NAT) as a reference. Sera from 380 consecutive hospitalized Ugandan patients were tested for anti‐HCV using an RSA in Uganda, with subsequent automated third‐generation EIA testing in the United States, followed by NAT. Recombinant immunoblot assays (RIBA) were used as a supplementary test to detect anti‐HCV epitopes. Overall, anti‐HCV was detected in 48/380 (13%) by one or both antibody tests. Anti‐HCV was detected in 19 (5.0%) patients by RSA and in 33 (8.7%) patients by EIA; only four patients were anti‐HCV positive by both methods. Fourteen of the 48 anti‐HCV positive patients had detectable serum HCV RNA, 7 each by bDNA assay or by PCR. RSA detected only 7 of 14 HCV RNA positive sera. Of 29 RNA negative but anti‐HCV positive patients tested by RIBA, only two were anti‐HCV positive; 27 were anti‐HCV negative or indeterminate. Anti‐HCV testing by RSA and/or EIA was neither sensitive nor specific for detection of ongoing HCV infection in hospitalized Ugandan patients. Our findings underscore the importance of confirmatory nucleic acid testing, which, despite its increased cost, appears essential to manage African patients with HCV. J. Med. Virol. 82:1371–1378, 2010. © 2010 Wiley‐Liss, Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Most hepatitis C testing in Uganda is performed using commercial rapid strip assays (RSA) to detect antibodies to hepatitis C virus (anti‐HCV), rather than enzyme immunoassays (EIA). The prevalence of hepatitis C antibodies in a Ugandan hospital population was determined using both methods to test their accuracy using nucleic acid testing (NAT) as a reference. Sera from 380 consecutive hospitalized Ugandan patients were tested for anti‐HCV using an RSA in Uganda, with subsequent automated third‐generation EIA testing in the United States, followed by NAT. Recombinant immunoblot assays (RIBA) were used as a supplementary test to detect anti‐HCV epitopes. Overall, anti‐HCV was detected in 48/380 (13%) by one or both antibody tests. Anti‐HCV was detected in 19 (5.0%) patients by RSA and in 33 (8.7%) patients by EIA; only four patients were anti‐HCV positive by both methods. Fourteen of the 48 anti‐HCV positive patients had detectable serum HCV RNA, 7 each by bDNA assay or by PCR. RSA detected only 7 of 14 HCV RNA positive sera. Of 29 RNA negative but anti‐HCV positive patients tested by RIBA, only two were anti‐HCV positive; 27 were anti‐HCV negative or indeterminate. Anti‐HCV testing by RSA and/or EIA was neither sensitive nor specific for detection of ongoing HCV infection in hospitalized Ugandan patients. Our findings underscore the importance of confirmatory nucleic acid testing, which, despite its increased cost, appears essential to manage African patients with HCV. J. Med. Virol. 82:1371–1378, 2010. © 2010 Wiley‐Liss, Inc. |
Seremba, E.; Ocama, P.; Opio, C. K.; Kagimu, M.; Yuan, H. J.; Attar, N.; Thomas, D. L.; Lee, W. M. Validity of the rapid strip assay test for detecting HBsAg in patients admitted to hospital in Uganda Journal Article In: Journal of Medical Virology, vol. 82, no. 8, pp. 1334-40, 0000. @article{Seremba2010b,
title = {Validity of the rapid strip assay test for detecting HBsAg in patients admitted to hospital in Uganda},
author = {E. Seremba and P. Ocama and C.K. Opio and M. Kagimu and H.J. Yuan and N. Attar and D.L. Thomas and W.M. Lee},
doi = {https://doi.org/10.1002/jmv.21813},
journal = {Journal of Medical Virology},
volume = {82},
number = {8},
pages = {1334-40},
abstract = {Commercially available rapid strip assays (RSAs) for hepatitis B surface antigen (HBsAg) are used for most routine clinical testing in sub-Saharan Africa. This study evaluated the validity of RSA and a more sophisticated enzyme immunoassay (EIA) with confirmation by nucleic acid testing (NAT) in hospitalized patients in Uganda. Sera from 380 consecutive patients collected and tested for HBsAg and anti-HIV in Kampala, Uganda by RSA were sent frozen to Dallas for EIA including HBsAg, total anti-hepatitis B core, hepatitis B e antigen, and anti-HIV. NAT was performed on all HBsAg-positives and on a random sample of 102 patients that were HBsAg-negative by both assays. Overall, 31 (8%) were HBsAg positive by RSA while 50 (13%) were HBsAg-positive by EIA; 26 were concordant between the two assays. Of 55 HBsAg-positive patients, nearly all showed detectable serum hepatitis B virus (HBV) DNA by bDNA (46) or PCR (4) assay. The 26 patients who were HBsAg positive by both EIA and RSA had significantly higher median serum HBV DNA levels than the 24 patients who were HBsAg positive by EIA alone. An additional 12/102 (12%) HBsAg negative patients had very low serum HBV DNA levels by NAT. Several differences in expected results of serologic testing were observed in this large series of African patients. RSA HBsAg testing is less sensitive than EIA; even EIA failed to detect all HBV DNA positive sera. A more complex testing protocol than RSA alone will be needed in Africa to improve patient care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Commercially available rapid strip assays (RSAs) for hepatitis B surface antigen (HBsAg) are used for most routine clinical testing in sub-Saharan Africa. This study evaluated the validity of RSA and a more sophisticated enzyme immunoassay (EIA) with confirmation by nucleic acid testing (NAT) in hospitalized patients in Uganda. Sera from 380 consecutive patients collected and tested for HBsAg and anti-HIV in Kampala, Uganda by RSA were sent frozen to Dallas for EIA including HBsAg, total anti-hepatitis B core, hepatitis B e antigen, and anti-HIV. NAT was performed on all HBsAg-positives and on a random sample of 102 patients that were HBsAg-negative by both assays. Overall, 31 (8%) were HBsAg positive by RSA while 50 (13%) were HBsAg-positive by EIA; 26 were concordant between the two assays. Of 55 HBsAg-positive patients, nearly all showed detectable serum hepatitis B virus (HBV) DNA by bDNA (46) or PCR (4) assay. The 26 patients who were HBsAg positive by both EIA and RSA had significantly higher median serum HBV DNA levels than the 24 patients who were HBsAg positive by EIA alone. An additional 12/102 (12%) HBsAg negative patients had very low serum HBV DNA levels by NAT. Several differences in expected results of serologic testing were observed in this large series of African patients. RSA HBsAg testing is less sensitive than EIA; even EIA failed to detect all HBV DNA positive sera. A more complex testing protocol than RSA alone will be needed in Africa to improve patient care. |
Katusiime, C.; Ocama, P.; Kambugu, A A case of palatal perforation caused by toxoplasmosis Journal Article In: Southern African Journal of HIV Medicine, 0000. @article{Katusiime2010c,
title = {A case of palatal perforation caused by toxoplasmosis},
author = {C. Katusiime and P. Ocama and A Kambugu},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/09/A-case-of-palatal-perforation-caused-by-toxoplasmosis.pdf},
journal = {Southern African Journal of HIV Medicine},
abstract = {HIV infection has several oral manifestations, including oral candidiasis and oral hairy leucoplakia. Occasionally unusual presentations requiring rigorous investigations are seen, and in these cases the diagnosis sometimes remains a dilemma owing to limited investigation facilities. (1-3) We present the case of a patient who presented with a puzzling oral lesion.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
HIV infection has several oral manifestations, including oral candidiasis and oral hairy leucoplakia. Occasionally unusual presentations requiring rigorous investigations are seen, and in these cases the diagnosis sometimes remains a dilemma owing to limited investigation facilities. (1-3) We present the case of a patient who presented with a puzzling oral lesion. |
