Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi

To investigae the association of human immunodeficiency virus (HIV) infection and carcinoma of the conjunctiva in Africa; and the role of human papilloma vius type 16 (HPV-16). Methods: Patients in Uganda nd Malawi presenting the eye clinics with lesions suspicious of carcinoma were studied. Pathological confirmation of eye lesions was sought. HIV testing of patients who were biopsied and; in Uganda; of mached case control subjects was carried out as was testing of a sample of fixed biopsies for HPV-16 by plymease chain reaction (PCR). The HIV-1 serology; histopathology of conjunctival bipsies (conjunctival intraepithelial neoplasia (CIN); invasive carcinoma; other lesions); and prevalence of HPV-16 infection were determined. Results: Of Ugandan patients; 27/38(71) with carcinoma( 27 invasive carcinoma; 11; CIN) were HIV positive compared with 12/76 (16) of controls (odds ration 13;95confidence interval 5-38). The calculated population aetiological fraction of carcinoma samples; 0/9 pingueculae; and 2/6 conjunctivitis samples. Conclusions: HIV infection is strongly associated with an apparent increase in the incidence of conjunctival carcinoma in Africa. While ultraviolet light is probably the prime risk factor and PHV-16 is implicated in a protection of cases; the interactions of ultraviolet light; HIV; HPVs; and other factors are unclear in the pathogenesis of carcinoma. The disease represents another model of multifactorial epithelial carcinogenesis

Efficacy of BCG vaccine against leprosy and tuberculosis in northern Malawi

Protection afforded BCG vaccines against tuberculosis and leprosy varies widely between different populations. In the only controlled trial which assessed protective efficacy of BCG (Danish and Pasteur strains) against both diseases; there was slightly more protection against leprosy than against tuberculosis. Protection was estimated at 50 percent or greater against leprosy; and there was no evidence for lower protection against multibacillary than against paucibacillary disease. There was no statistically significant protection by BCG against tuberculosis in this population