'We are no longer called club members but caregivers': Involving youth in HIV and AIDS caregiving in rural Zambia.

This study assessed the strategy of building young people's capacity to provide care and support to people living with HIV and AIDS in rural Zambia. Members of youth anti-AIDS clubs in schools and communities were trained as adjunct caregivers using a locally developed curriculum that allowed them to explore and challenge gendered notions of caregiving and emphasized networking with existing resources. Results show that caregiving increased among males (47% to 82%) and females (41% to 78%). Both sexes provided similar caregiving services, including help with household chores and personal care tasks. Youth also undertook activities with children to decrease their isolation, help them stay in school, and reach additional services. While clients and caregivers reported positive aspects of the programme, both reported frustration with the youths' inability to meet material needs. This study demonstrates that trained youth already involved in anti-AIDS efforts can meet a range of care needs and be valuable assets to their community. It also highlights the importance of communicating clearly what youth can and cannot do, ongoing monitoring and support of youth caregivers, and involving community leaders to give youth credibility and access to local resources.

Predominance of subtype A and G HIV type 1 in Nigeria, with geographical differences in their distribution.

The purpose of this study was to generate data on the relative prevalences of the HIV-1 subtypes circulating in Nigeria. A total of 252 HIV-1-positive samples collected during an epidemiologic survey conducted in April 1996 were genetically characterized by HMA (heteroduplex mobility assay) and/or sequencing. Samples were collected in Lagos, Calabar, Kano, and Maiduguri. Overall, the predominant env subtypes were A (61.3%) and G (37.5%). Subtype A is more prevalent in the south (p < 0.001), about 70% in Lagos and Calabar, whereas a quarter of the samples was classified as subtype G in these states. In contrast, subtype G is predominant in the north ( < 0.001), representing 58% of the samples in Kano. In the northeastern region, Maiduguri, almost similar proportions of subtype A and G were seen, 49 and 47.4%, respectively. A total of 37 samples was also sequenced in the p24 region from the gag gene; 13 (35%) had discordant subtype designations between env and gag. The majority of the gag (12 of 17) and env (14 of 22) subtype A sequences clustered with the A/G-IBNG strain. Within subtype G, three different subclusters were seen among the envelope sequences. These different subclusters are observed among samples obtained from asymptomatic individuals and AIDS patients from the four Nigerian states studied. In conclusion, we observed a limited number of HIV-1 subtypes circulating in Nigeria, with subtypes A and G being the major env subtypes responsible for the HIV-1 epidemic. Nevertheless, the high rate of recombinant viruses (A/G) and the different A/G recombinant structures indicate a complex pattern of HIV-1 viruses circulating in this country.

The identification of a complex A/G/I/J recombinant HIV type 1 virus in various West African countries.

In this sequence note we describe the full-length genome sequence of an HIV-1 isolate originating from the west African country of Mali. The phylogenetic tree analysis from the near full-length genome shows that the 95ML84 strain forms a separate cluster, supported by 100% of the bootstrap values, with the previously described A/G/J/? mosaic virus BFP90 from Burkina Faso. Additional analysis showed that throughout the genome the lowest diversity was seen between the 95ML84 and the BFP90 viruses, and bootscan analysis showed a similar complex genomic structure. In addition to the initial report describing the BFP90 virus as an A/G/J/? recombinant, our data show that for the BFP90 and 95ML84 strains the unclassified region corresponds to subtype I. The A/G/I/J BFP90 and 95ML84 strains represent the fifth and most complex circulating recombinant form of HIV-1 detected so far, and our data show its presence in various West African countries. Subtype I and J sequences, initially considered rare, seem to have broadened their geographical spread by way of these recombinant forms.

Genetic characterization of the nef gene from human immunodeficiency virus type 1 group M strains representing genetic subtypes A, B, C, E, F, G, and H.

Most efforts to characterize sequence variation of HIV isolates has been directed toward the structural envelope gene. Few studies have evaluated the sequence variability of auxiliary genes such as nef. In this study 41 new HIV-1 strains, representing the majority of the described envelope subtypes of HIV-1 (A to H), were genetically characterized in the nef region. Phylogenetic analysis showed that 34 strains could be classified in the same subtype in nef and env, and 7 (19%) of the 41 new viruses were recombinants. For two of the seven strains, recombination occurred upstream of the nef gene, whereas for five of the seven strains recombination occurred within the nef gene with a crossover close to the 5' end of the LTR (long terminal repeat). The low intersubtype distance between subtype B and D in the nef gene confirms previous observations in the pol, env, and gag genes, which suggest a common ancestor for these subtypes. The majority of all the previously described functional domains in the nef gene were relatively conserved among the different subtypes, with only minor differences being observed. The myristoylation signal among the different subtypes, with only minor differences being observed. The myristoylation signal was less conserved for subtype C, with one or more amino acid changes being observed at positions 3, 4, and 5. The highly conserved acidic region (positions 62 to 65), critical for the enhancement of viral synthesis with an increased virus growth rate, was less conserved among the subtype G strains from our study. At least three epitopic regions of the nef gene have been defined and each can be recognized by CTLs under a variety of HLA restrictions; all were also relatively well conserved between the different genetic subtypes. Despite the relatively important genetic variation in nef sequences obtained among the different genetic subtypes, functional domains and CTL epitopes were relatively well conserved. In vitro and/or in vivo studies are necessary to study the relevance of the observed differences.

Seroprevalence of HIV-1, HIV-2, and HIV-1 group O in Nigeria: evidence for a growing increase of HIV infection.

To determine current data on HIV infection and to further confirm the presence of HIV-1 group O infection in Nigeria, 2300 samples from five states were tested for the presence of HIV antibody. A convenience sampling was obtained from pregnant women, tuberculosis (TB) patients, commercial sex workers (CSWs), blood donors, patients with sexually transmitted diseases (STDs), patients with skin diseases, male clients of CSWs, outpatients suspected to have AIDS, truck drivers, and community dwellers. With the exception of pregnant women, the HIV prevalences in all these groups were high: 60.6% in CSWs, 16.2% in TB patients, 7.7% in blood donors in some states, and 16% in the rural area of Kano State. Male clients of CSWs, truck drivers, and STD patients had prevalences of 7.8%, 8.6%, and 21.2%, respectively. Regional differences in relation to HIV prevalences were observed; HIV-2 and most of the HIV-1/2 infections were found in the southern states of Nigeria. Higher HIV prevalences were observed in the north-northeast in pregnant women, TB patients, and CSWs, but for blood donors, higher rates were seen in the southeast-southwest. One asymptomatic 50-year-old woman, a community dweller in Kano, was identified to be HIV-1 group O-positive. Compared with data from national surveillance studies in 1991/1992 and 1993/1994, a substantial increase in HIV infection was observed. Our results show a growing incidence of HIV infection in Nigeria and suggest the presence of a rural HIV epidemic. The identification of HIV-1 group O in Kano shows that this virus strain is geographically widespread in Nigeria.

PIP: To obtain current data on HIV infection in Nigeria by population group, a seroanalysis of 2300 samples from 5 states (Lagos, Cross River, Borno, Kano, and Jugawa) was conducted during March-May 1996. The sample included commercial sex workers, pregnant women, tuberculosis patients, blood donors, patients with sexually transmitted diseases (STDs), patients with skin diseases, male clients of commercial sex workers, outpatients suspected to have AIDS, truck drivers, and community residents. Overall HIV prevalence was 40.7%. With the exception of pregnant women (1.7%), HIV prevalence was high in all subgroups: 60.6% in commercial sex workers, 21.2% in STD patients, 16.2% in tuberculosis patients, and 16.0% in rural areas of Kano state. The majority of HIV-positive women were 21-30 years of age, while HIV-infected men were primarily over 40 years of age. Compared with data from national seroprevalence studies conducted during 1991-92 and 1993-94, this study confirms a substantial recent increase in HIV infection in Nigeria. Of the 330 antibody-positive specimens, HIV-1 was the predominant infection in 315; there were 3 cases of HIV-2 and 12 cases involving dual HIV-1/2 infection. Only 1 serum sample was positive for HIV-1 group O antibodies. The high HIV prevalence detected among commercial sex workers indicates the potential for rapid diffusion of HIV to the general population.

Geographical distribution of HIV-1 group O viruses in Africa.

OBJECTIVE: To determine to what extent HIV-1 group O strains are present in different African countries. MATERIALS AND METHODS: A total of 14,682 samples of sera from a range of patients from 12 different African countries were tested. All the sera were tested with an enzyme-linked immunosorbent assay (ELISA) using a combination of V3 peptides from ANT-70 and MVP-5180. Samples reactive in ELISA were retested in a line immunoassay (LIA-O). Samples reactive in ELISA were also retested with an in-house Western blot to determine the presence of antibodies to gp120 of HIV-1 ANT-70. Polymerase chain reaction was performed on HIV-1 group O and group O indeterminate sera. RESULTS: Of all the sera samples tested, only 19 sera had antibodies to group O V3 peptides exclusively and 46 were indeterminate for group O infection in LIA-O. The highest prevalence of HIV-1 group O infection among HIV-positive sera was observed in Cameroon (2.1%) and neighbouring countries, 1.1% in Nigeria and 0.9% in Gabon. The lowest rates were seen in west Africa: 0.07% in Senegal, 0.14% in Togo, 0.16% in Chad and 0.3% in Niger. Group O sera were observed in almost all the population categories tested. The ANT-70 V3 peptide in LIA-O was reactive with all of the sera considered to be HIV-1 group O antibody positive by LIA, versus 78.9% for the MVP-5180 peptide. Thirteen out of 19 group O samples of sera were tested in PCR. Eight samples were identified as group O by specific group O pol and/or V3 primers; in the remaining five samples no HIV RNA could be detected. Of the indeterminate sera samples, two were identified as group O. CONCLUSION: In eight of the 12 countries tested, antibodies to group O viruses were identified. Numbers of HIV-1 group O viruses are low. Their presence is not restricted to Cameroon and neighbouring countries but can also be found in west and south-east Africa.

PIP: An enzyme-linked immunosorbent assay (ELISA), using a combination of V3 peptides and ANT-70 and MVP-5180, was used to test 14,682 sera samples from people living in Burkina Faso, Burundi, Cameroon, Chad, Congo, Gabon, Mali, Niger, Nigeria, Senegal, Togo, and Zambia to examine the geographic spread of HIV-1 group O viruses in Africa. An in-house Western blot and a line immunoassay (LIA-O) were used to detect the presence of antibodies to gp120 of HIV-1 ANT-70 of samples reactive in ELISA and then a polymerase chain reaction (PCR) on HIV-1 group O and group O indeterminant sera. HIV-1 group O antibodies were present in 8 countries (Cameroon, Chad, Gabon, Niger, Nigeria, Senegal, Togo, and Zambia). Among these 8 countries, the prevalence of HIV-1 group O sera ranged from 2.1% in Cameroon to 0.07% in Senegal. Cameroon and its neighboring countries had a higher prevalence than the West African countries (0.9-2.1% vs. 0.07-0.3%) and Zambia. HIV-1 group O virus was more or less evenly distributed among the population groups tested. The ANT-70 V3 peptide in LIA-O had a higher reactivity rate with HIV-1 group O sera than MVP-5180 V3 peptide in LIA-O (100% vs. 78.9%). 8 of the 13 samples tested in PCR were identified as group O by specific group O pol and/or V3 primers. Among the remaining 5 indeterminant sera samples, 2 were identified as group O. Prospective studies are needed to monitor the true prevalence of HIV-1 group O viruses in Cameroon, its neighboring countries, and West Africa. They are also needed to determine the risk factors associated with group O infection. Monitoring these viruses will allow adaptation of HIV testing strategies for blood screening and serodiagnosis if required.