Did the 2014 Ebola outbreak in Liberia affect HIV testing, linkage to care and ART initiation?

Setting: Health facilities providing human immunodeficiency virus (HIV) testing, care and treatment in Liberia. Objective: To evaluate individuals aged ⩾15 years who were tested, diagnosed and enrolled into HIV care before (2013), during (2014) and after the Ebola outbreak (2015). Design: A cross-sectional descriptive study. Results: A median of 6930 individuals aged ⩾15 years per county were tested for HIV before the Ebola outbreak; this number declined by 35% (2444/6930) during the outbreak. HIV positivity remained similar before (7028/207 314, 3.4%) and during the outbreak (4146/121 592, 3.5%). During Ebola, HIV testing declined more in highly affected counties (68 035/127 468, 47%) than in counties that were less affected (16 444/23 955, 31%, P < 0.001). Compared to the pre-Ebola period, HIV testing in less-affected counties recovered more quickly during the post-outbreak period, with a 19% increase in testing, while medium and highly affected counties remained at respectively 38% and 48% below pre-outbreak levels. Enrolment for HIV care increased during and after the outbreak compared to the pre-Ebola period. Conclusion: HIV testing and diagnosis were significantly limited during the Ebola outbreak, with the most severe effects occurring in highly affected counties. However, enrolment for HIV care and treatment were resilient throughout the outbreak. Pro-active measures are needed to sustain HIV testing rates in future epidemics.

Contexte : Structures de santé offrant des tests et une prise en charge de l'infection par le virus de l'immunodéficience humaine (VIH) au Liberia.Objectif : Evaluer les personnes âgées de ⩾15 ans qui sont testées, diagnostiquées et enrôlées dans la prise en charge du VIH avant (2013), pendant (2014) et après la flambée d'Ebola (2015).Schéma : Étude descriptive transversale.Résultats : Une médiane de 6930 personnes âgées de ⩾15 ans par comté ont eu un test VIH avant la flambée d' Ebola ; ce nombre a décliné de 35% (2444/6930) pendant la flambée. La positivité du VIH est restée similaire avant (7028/207 314 ; 3,4%) et pendant la flambée d'Ebola (4146/121 592 ; 3,5%). Pendant Ebola, les tests VIH ont diminué davantage dans les comtés les plus affectés (68 035/127 468 ; 47%) comparés aux comtés moins affectés (16 444/23 955 ; 31% ; P < 0,001). Comparés à la période pré Ebola, les tests VIH dans les comtés les moins affectés ont récupéré plus rapidement pendant la période post flambée, avec une augmentation de 19% des tests, tandis que les comtés moyennement ou très affectés sont restés à 38% et à 48%, respectivement, sous les niveaux d'avant la flambée. L'enrôlement dans la prise en charge du VIH a augmenté pendant et après la flambée par rapport à la période pré Ebola.Conclusion : Le test et le diagnostic du VIH ont été significativement limités pendant la flambée d'Ebola, avec l'impact le plus grave dans les comtés les plus affectés. L'enrôlement dans la prise en charge du VIH a toutefois été résilient tout au long de la flambée. Des mesures proactives sont requises pour maintenir le taux des tests VIH lors de futures épidémies.

Marco de referencia: Los establecimientos de salud que prestan servicios de diagnóstico, atención y tratamiento de la infección por el virus de la inmunodeficiencia humana (VIH) en Liberia.Objetivo: Evaluar el número de personas de edad de ⩾15 años en quienes se practicó la prueba del VIH, se estableció el diagnóstico de infección por el virus y se inscribieron en el servicio de atención antes la epidemia de fiebre hemorrágica del Ébola (2013), durante el brote (2014) y después del mismo (2015).Método: Fue este un estudio transversal descriptivo.Resultados: La mediana del número de personas de edad de ⩾15 años en quienes se practicó la prueba del VIH antes del brote del Ébola por condado fue 6930; esta cifra disminuyó un 35% (2444/6930) durante el brote. La proporción de resultados positivos de la prueba permaneció estable antes del brote epidémico (7028/207 314 ; 3,4%) y durante el mismo (4146/121 592 ; 3,5%). Durante la epidemia del Ébola, la práctica de la prueba del VIH disminuyó más en los condados más afectados (68 035/127 468; −47%) que en los condados con una epidemia de menor nivel (16 444/23 955; −31%; P < 0,001). En comparación con el período pre-Ébola, la recuperación de la práctica de la prueba del VIH después de la epidemia en los condados menos afectados fue más rápida, con un aumento del 19%, pero en los condados donde la epidemia alcanzó un nivel intermedio o alto, las cifras permanecieron un 38% y un 48% inferiores al período pre-Ébola, respectivamente. La inscripción al programa de atención de la infección por el VIH aumentó durante el brote y después del mismo, en comparación con el período pre-Ébola.Conclusión: Los resultados del presente estudio revelan que las pruebas y el diagnóstico de la infección por el VIH se redujeron de manera notable durante el brote epidémico del Ébola y los efectos fueron más acentuados en los condados donde la epidemia alcanzó un alto nivel. Sin embargo, la inscripción al programa de atención y tratamiento resistió durante toda la epidemia. Se precisan medidas anticipatorias que favorezcan la estabilidad de la práctica de la prueba diagnóstica del VIH durante las epidemias futuras.

Topical chemotherapy of cutaneous Leishmaniasis.

Cutaneous leishmaniasis (CL) is one of the most important causes of chronic ulcerative skin lesions. The disease is endemic in many parts of the world, presenting a range of clinical forms - acute, chronic, recurrent and diffuse(1). Several species of Leishmania are involved, including L. major, L. tropica and L. aethiopica in the Old World, and several members of the L. braziliensis and L. mexicana complexes in the New World. Some forms of the disease produce only mild, self-limited lesions, while at the other extreme are the destructive mucocutaneous forms caused by L. braziliensis and L. panamensis(1-7). In all cases, chemotherapy tends to be difficult - often requiring prolonged parenteral administration of toxic drugs such as pentavalent antimonials or amphotericin B. Such drugs are also expensive and relatively inefficient in the sense that much of the active ingredient is excreted by the patient before reaching its target. Consequently, there is renewed interest in the development of active formulations suitable for topical application directly onto the lesions.

A note on the effect of gamma-rays on cefamandole and oxacillin.

The feasibility of the radiation sterilization of two beta-lactam antibiotic powders, cefamandole nafate and oxacillin sodium, has been examined by subjecting them to a range gamma-radiation doses, followed by chemical and microbiological analyses. It would appear feasible to radiation sterilize oxacillin sodium. The radiation sterilization of cefamandole nafate may be realistic at low doses or under conditions that minimize radiolysis.

Radiosensitization by diamide analogs and arsenicals.

Several analogs of the glutathione (GSH) oxidizing reagent diamide [diazenedicarboxylic acid bis(N,N'-diethylamide)] were tested as radiosensitizers of aerobic cells. In general, radiosensitization correlates with the rate of reaction with cellular reducing agents and occurs only when the reductive capacity of the cell is exceeded. SR-4077, [diazenedicarboxylic acid bis(N,N-piperidide)], is particularly suitable for mechanistic studies, because it is less cytotoxic than diamide, but is equally reactive toward cellular GSH. SR-4077 sensitizes CHO cells to X rays under aerobic conditions, even when the drug is added after irradiation. Radiosensitization is expressed both as a change in the exponential slope of the radiation cell survival curve and as a decrease in the shoulder of the survival curve. Phenylarsine oxide, a dithiol-binding reagent, sensitizes aerobic CHO cells to X rays by modification of the shoulder of the survival curve. The results are consistent with the hypothesis that the shoulder-modifying effect of GSH oxidants is caused by the loss of protein thiols, which might be involved in the repair of X ray-induced DNA damage.

The contribution of endogenous and exogenous effects to radiation-induced damage in the bacterial spore.

Radical scavengers such as polyethylene glycol 400 and 4000 and bovine albumin have been used to define the contribution of exogenous and endogenous effects to the gamma-radiation-induced damage in aqueous buffered suspensions of Bacillus pumilus spores. The results indicate that this damage in the bacterial spore is predominantly endogenous both in the presence of 1 atmosphere of oxygen, and in anoxia.

The development of a formulation for radiation-sterilizable urea broth.

Urea broth, a medium used for the identification of the genus Proteus, was sterilized by gamma radiation, using radiation doses of 1-1.5 Mrad. The radiation-sterilized medium, modified by adding sodium ascorbate and increasing its phenol red and yeast extract content, performed as well as the commercial formulation prepared aseptically, when tested with different Proteus and non-Proteus species. Gamma-irradiation appears to be an attractive and economical method for sterilizing nutrient media in sealed tubes, avoiding the risk of contamination during processing.

Development of topical treatment for cutaneous leishmaniasis caused by Leishmania major in experimental animals.

Topical treatment, with drug-containing ointments, of cutaneous leishmaniasis caused by Leishmania major in BALB/c mice was studied. Twenty chemotherapeutic agents having potential or established antileishmanial activity were formulated in different ointment and cream bases. Only 15% paromomycin sulfate with 12% methylbenzethonium chloride, 12% benzethonium chloride, 12% cetalkonium chloride, or 12% dimethyl sulfoxide, all incorporated in white soft paraffin (United Kingdom patent application no. 2117237A), were completely effective. Topical treatment twice daily for 6 or more days caused total elimination of the parasites and healing of the lesion in all treated mice. All the other antileishmanial compounds, including sodium stibogluconate, pentamidine, amphotericin B, emetine hydrochloride, metronidazole, co-trimoxazole, allopurinol, and rifampin, either showed a slight effect on the parasites or were highly toxic to the animal host at the concentrations tested.

Hypoxic radiosensitization by the antimicrobial methyl paraben.

The antimicrobial preservative, methyl paraben (methyl-4-hydroxybenzoate) sensitizes anoxic buffered suspensions of Staphylococcus aureus to gamma-radiation. The maximal response at an 0.5 mM concentration represents a 150 percent increase in response over that for deoxygenated suspensions without additive (E.R. = 2.5), and 80 percent of the response for aerated suspensions alone. Methyl paraben is not toxic to the test organism under the present test conditions.

Giant right atrial myxoma with rheumatic mitral valve disease.

A patient with a 456 Gram right atrial myxoma is described. Associated rheumatic mitral valvular heart disease obscured the presence of the tumor and only with presentation of bradyarrhythmias leading to pacemaker implantation was the diagnosis suspected. Successful surgical removal of the tumor and correction of the intracardiac valvular dysfunction were performed. The role of echocardiography in the early detection of these tumors is reinforced.

Radiosensitization of Staphylococcus aureus by secobarbital sodium and other barbiturates.

The barbiturate hypnotic, secobarbital sodium, at millimolar concentrations, sensitizes Staphylococcus aureus in anoxic buffer-saline suspension (pH 7.0) to the lethal effects of gamma rays. The maximal response represents 50% of that for oxygenated suspensions without additive. Secobarbital sodium operates within the oxygen effect. It must be present at the time of irradiation for modification of radiation response. This, coupled with its testing in the presence of other additives, points to its involvement in an intracellular reaction with a radiation-induced short-lived chemical species, probably the electron. Preliminary tests show that pentobarbital sodium also operates as an efficient hypoxic radiosensitizer. Lack of sensitization by phenobarbital sodium is attributed to its low lipid solubility.

The radiation-induced inactivation of microorganisms in non-aqueous suspension: The effect of selected alcohols and paraffins on the radiation sensitivity of aerated Bacillus pumilus spores.

The effect of model compounds comprising alcohols and paraffins on the radiation sensitivity of B pumilus spores has been carried out with the aim of understanding the radiation-induced inactivation of microorganisms when suspended in non-aqueous medium. This study is a prerequisite to the undertaking of radiation sterilization of non-aqueous pharmaceuticals. Spores of B. pumilus E601 mounted on kaolin powder were suspended in the appropriate organic agent and gamma irradiated under oxic conditions. Spores suspended in paraffins displayed increased radiation response over that for aerated buffered suspensions. Values of inactivation constant ranged between 2X and 5X for that buffer. Less pronounced modification of response was obtained for the alcohols. The results reveal a marked tendency for response to increase with decreasing polarity of the suspending fluid. The partial miscibility of the alcohols in water enabled the examining of the transition from the response characteristic of aerated buffered suspensions to those of the spores in pure organic liquids.

Aprindine psychosis.

A young woman with mitral valve prolapse and ventricular tachycardia refractory to numerous antiarrhythmics, received a trial of aprindine. During the course of treatment she developed a severe psychotic reaction that resolved after the drug was stopped. Her psychosis was unassociated with the other dose-related neurological side effects of aprindine, and occurred at borderline therapeutic levels of the drug.