ABSTRACT
The need for viral load (VL) monitoring of HIV patients receiving antiretroviral therapy (ART) in resource-limited settings (RLS) has become apparent with studies showing the limitations of immunological monitoring. We compared the Abbott m2000 Real-Time (Abbott) HIV-1 assay with the Roche AMPLICOR Monitor v1.5 (Roche) HIV-1 assay over a range of VL concentrations. Three hundred and eleven plasma samples were tested, including 164 samples from patients on ART ≥ six months and 147 from ART-naïve patients. The Roche assay detected ≥400 copies/mL in 158 (50.8%) samples. Of these, Abbott produced 145 (91.8%) detectable results ≥400 copies/mL; 13 (8.2%) samples produced discrepant results. Concordance between the assays for detecting HIV-1 RNA ≥400 copies/mL was 95.8% (298/311). The sensitivity, specificity, positive predictive value and negative predictive value of Abbott to detect HIV-1 RNA ≥400 copies/mL were 91.8%, 100%, 100% and 92.2%, respectively. For the 151 samples with HIV-1 RNA ≥400 copies/mL for both assays, a good linear correlation was found (r = 0.81, P < 0.0001; mean difference, 0.05). The limits of agreement were -0.97 and 1.07 log(10) copies/mL (mean ± 2 SD). The Abbott assay performed well in our setting, offering an alternative methodology for HIV-1 VL for laboratories with realtime polymerase chain reaction (PCR) capacity.
Subject(s)
HIV Infections/virology , HIV-1/isolation & purification , Molecular Diagnostic Techniques/methods , Plasma/virology , Viral Load/methods , Anti-HIV Agents/administration & dosage , Drug Monitoring/methods , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Predictive Value of Tests , RNA, Viral/blood , Sensitivity and Specificity , UgandaABSTRACT
HIV acquisition is associated with herpes simplex virus type 2 (HSV-2) infection and genital ulcer disease (GUD). Three randomized control trials demonstrated that male circumcision significantly decreases HIV, HSV-2, human papillomavirus and self-reported GUD among men. GUD is also decreased among female partners of circumcised men, but it is unknown whether male circumcision status affects GUD pathogens in female partners. For the evaluation of GUD aetiology, two separate multiplex assays were performed to detect Haemophilus ducreyi, Treponema pallidum, HSV-1 and HSV-2. Of all the female GUD swabs evaluated, 67.5% had an aetiology identified, and HSV-2 was the primary pathogen detected (96.3%). However, there was no difference in the proportion of ulcers due to HSV-2 or other pathogens between female partners of circumcised men (11/15, 73.3%) compared with uncircumcised men (15/25, 60.0%, P = 0.39). The seroprevalence of HSV-2 is high in this population and therefore most of the detected HSV-2 infections represent reactivation. Since GUD is associated with HIV acquisition and one-third of GUD in this study did not have an aetiological agent identified, further research is needed to better understand the aetiology of GUD in Africa, and its relationship to circumcision and HIV infection.
Subject(s)
Circumcision, Male , Genital Diseases, Female/etiology , Herpesvirus 2, Human/isolation & purification , Sexual Partners , Female , HIV Seronegativity , Humans , Male , Uganda , UlcerABSTRACT
Six hundred and twenty antenatal, 40 post normal delivery 40 post caesarian section, 4 patients with placenta previa and 3 with fresh still section, 4 patients with placenta previa and 3 with fresh still births were investigated for feto maternal haemorrhage. The prevalence of feto maternal haemorrhage was 32.2% for antenatal patients, 45% for post caesarian section ones and 25% after normal delivery. All the values were higher than in Caucasian studies. Antenatal prevalence increased with gestation being 15.4% in first trimester, 29.5% in second and 38% in third trimester (p 0.05). Maternal age, parity, number of previous abortions and marital status did not influence the prevalence. Increased feto maternal haemorrhage was associated with history of vaginal bleeding or trauma but not pre-eclampsia. Feto maternal macrotransfusion was detected in 1% of antenatal patients, two patients with abruptio placenta, one with still birth and eight delivered by caesarian section. The mode of delivery did not influence the frequency but affected the volume of feto maternal transfusion. Probable changes in the timing of prophylactic anti D-gammaglobulin are discussed.
Subject(s)
Fetomaternal Transfusion/epidemiology , Cesarean Section/statistics & numerical data , Cross-Sectional Studies , Delivery, Obstetric/methods , Female , Fetomaternal Transfusion/blood , Fetomaternal Transfusion/etiology , Gestational Age , Hospitals, Urban , Humans , Kenya/epidemiology , Pregnancy , PrevalenceABSTRACT
In a study to assess the efficacy of and safety of vacuum aspiration syringe in the management of incomplete abortion 300 patients with non septic abortion were evacuated by the method in the ward. A control group 285 patients was evacuated in theatre by sharp currettage. All patients were followed up for 21 days. 54.7% of the study patients were evacuated without any need for analgesia while all the control patients were given intravenous pethidine and valium. 2.3% of vacuum aspiration and 3.5% of control patients needed revacuation (p greater than 0.05). 70.3% of vacuum aspiration cases were dry by day 7 compared to 64.6% of the control group (p greater than 0.05). Immediate complications of nausea and vomiting were seen in 5.3% study patients (p less than 0.001). There was one uterine perforation in the control group. 5.4% of study and 6.0 of control patients developed mild to severe sepsis (p greater than 0.05). Vacuum aspiration is a safe, simple and quick method of treating incomplete abortion. Its wider use in developing countries is highly recommended.
