Chronic Lung Disease in Patients With Perinatally Acquired HIV in England: A Retrospective Case-Note Review.

Chronic lung disease (CLD) is common in individuals living with perinatally acquired HIV (PA-HIV) in southern/eastern Africa. Most of the UK PA-HIV population are African. We conducted a case-note review of CLD in 3 UK PA-HIV cohorts (n = 98). Bronchiectasis or obliterative bronchiolitis occurred in 8.1% of patients and ring/tramline opacities occurred in 19.2% of patients on chest radiograph. There may be unrecognized and underdiagnosed CLD among PA-HIV in the UK.

Cerebro-meningeal infections in HIV-infected patients: a study of 116 cases in Libreville, Gabon.

BACKGROUND: Cerebro-meningeal pathology is common in human immunodeficiency virus (HIV) infection and the aetiology is often difficult to ascertain with certainty. OBJECTIVE: To describe the major suspected and identified causes of meningeal or encephalitic syndromes in HIV infection in Libreville, Gabon. METHODS: A descriptive study using clinical records of patients hospitalised in the Department of Medicine in the Military Hospital of Libreville (Gabon) between January 2006 and May 2010. Clinical features were evaluated using multivariable logistic regression to evaluate association with the outcome of a clinical improvement or death. RESULTS: The most frequent neurological symptoms were reduced level of consciousness (54.3%), headache (55.2%), motor deficit (38.7%), and convulsions (36.2%). Cerebral toxoplasmosis represented 64.7% of diagnoses, followed by cryptococcal neuromeningitis in 12.9% of cases. Tuberculoma was diagnosed in 4 cases and lymphoma in 2 cases. In 9.5% of cases, no aetiology was determined. Toxoplasmosis treatment led to clinical improvement in 69.3% of cases with suspected cerebral toxoplasmosis. Overall mortality was 39.7%. CONCLUSION: The diagnosis of neurological conditions in HIV positive patients is difficult, particularly in a low-resource setting. A trial of treatment for toxoplasmosis should be initiated first line with all signs of neurological pathology in a patient infected with HIV.

Estimating the number of HIV-positive pregnant women in Sergipe, Brazil, using capture-recapture.

The objective of the study was to estimate the population of HIV-seropositive pregnant women in the State of Sergipe between 2000 and 2010, using the capture-recapture method (CRC). Three databases were used as independent lists: The Brazilian Case Registry Database (SINAN), Laboratory Test Control System (SISCEL) and medical data records of the STD/HIV/AIDS service of Sergipe (CEMAR). For analysis, a log-linear regression model was used to ascertain the total population size. We identified 729 HIV-seropositive pregnant women from the three lists. Among them, only 317 (43.5%) were included in SINAN, 646 (88.6%) were included in SISCEL and 274 (37.6%) appeared in the CEMAR database. Using CRC, we estimated that there were in total 1110 HIV-seropositive pregnant women; therefore, 381 (34.3%) women were not captured by any of the three systems. The CRC method is a potentially useful and important tool in the evaluation of official reporting systems in Brazil.

Impact of rotavirus vaccination on diarrhoea mortality and hospital admissions in Brazil.

OBJECTIVE: To analyse the data reported by the national surveillance system of Brazil, including data on diarrhoea mortality and hospital admissions before and after rotavirus vaccine introduction, and evaluate the impact of its widespread use under operational conditions. METHOD: Retrospective analysis of routinely collected data was reported by several surveillance systems of Brazil, comprising an 8-year period of all diarrhoea-related hospitalisations and deaths in children <5 years old (2002-2009). Linear regressions were used to compare trends of diarrhoea hospitalisations and deaths before and after vaccine introduction (2002-2005 vs. 2006-2009). RESULTS: There was a long-term reduction in hospitalisations that preceded the introduction of the vaccine. This reduction was more marked in <1-year-old than in 1- to 4-year-old children. All-cause diarrhoea hospitalisations decreased further after vaccine introduction and the decrease was larger in <1-year-old (-35.6%) than in 1- to 4-year-old children (-12.3%). The number of deaths was decreasing before vaccine introduction, and the decrease also accelerated after vaccine introduction, with deaths halving in <1-year-old and decreasing by 32.9% in 1- to 4-year-old children. The linear relationships between hospitalisations and deaths were statistically different before and after vaccine introduction. CONCLUSIONS: The data demonstrate a decreasing trend in all-cause diarrhoea-related hospitalisations and deaths in children <5 years of age. These reductions were steeper between 2006 and 2009, highlighting the potential beneficial effect of the rotavirus vaccine associated with all-cause diarrhoeal disease.

Estimating the number of street children and adolescents in two cities of Brazil using capture-recapture.

AIM: To use the capture-recapture method to estimate the number of street children and adolescents in Maceió and Arapiraca, north-east Brazil, and describe the characteristics of the two populations. METHODS: The number of children and adolescents on the street in Maceió and Arapiraca was estimated using the multi-list capture-recapture method. Two street surveys and an official list from the social services department were compared. The characteristics of the children were recorded during the street surveys using a questionnaire. RESULTS: The estimated number of street children and adolescents was 5225 in Maceió and 1191 in Arapiraca. According to the official records, the population registered was 565 and 157, respectively. Most individuals were male (71.4% and 71.8%, respectively). They still maintain contact with their families (85.5% in Maceió and 89.6% in Arapiraca) and attend school regularly (43.4% and 49.7%). Drug use was admitted by 46.9% of the individuals in Maceió and by 26.9% in Arapiraca. In both cities, glue inhalation, associated or not with other drugs, was most frequently cited. CONCLUSIONS: Children and adolescents on the streets are a common and underestimated occurrence in Maceió and Arapiraca. They have similar characteristics to street children from other countries and other cities in Brazil. The method of capture-recapture seems to be suited to study populations such as street children.

Estimating the post-neonatal prevalence of sickle cell disease in a Brazilian population.

SUMMARY OBJECTIVE: To estimate the prevalence of individuals with sickle cell disease (SCD) in Aracaju, Brazil, using the capture-recapture (CRC) method. SCD is a significant public health problem with long-term life-threatening complications. There are no reliable estimates of the number of individuals with this condition in Aracaju, north-east Brazil. The CRC method has been used to quantify other ubiquitous populations. METHOD: Three independent lists of individuals with homozygous (HbSS) SCD were constructed from patients attending the main specialist ambulatory service, all patients with SCD admitted to three government hospitals and a clinic providing specialist immunisation services to patients with SCD. Individuals were matched to ascertain whether they appeared in one, two or three lists, and population size was estimated using the log-linear model. RESULTS: The lists identified 374 individuals. Two hundred and one appeared in one, 99 in two and 74 in three lists with an estimated number 400 (95% CI 387-418) HbSS SCD individuals; 51.6% patients with SCD were men and age ranged from 1-62 years (median 14). CONCLUSION: The CRC method resulted in a smaller population estimate than expected. The causes of this discrepancy may include list dependence, high mortality with a survival cohort effect and the method of identifying the more severe cases. The CRC method has potential to estimate the size of this population and could supplement neonatal screening to further characterise the SCD population in this region.