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1.
Int J Tuberc Lung Dis ; 24(10): 1024-1031, 2020 10 01.
Article in English | MEDLINE | ID: mdl-33126934

ABSTRACT

BACKGROUND: Bedaquiline (BDQ) has not been extensively studied among patients co-infected with HIV drug-resistant tuberculosis (DR-TB). We compared treatment outcomes in DR-TB patients treated with BDQ- and linezolid (LZD) containing regimens to historic controls treated with second-line injectable-containing regimens.METHODS: Retrospective cohort study of consecutive DR-TB patients initiated on BDQ- and LZD-containing regimens at a TB referral hospital in KwaZulu-Natal, South Africa. Participants were prospectively followed through 24 months for treatment outcome and adverse events. Outcomes were compared to a historic control cohort of DR-TB HIV patients enrolled at the same facility prior to BDQ introduction.RESULTS: Adult DR-TB patients initiating BDQ between January 2014 and November 2015 were enrolled (n = 151). The majority of patients were female (52%), HIV co-infected (77%) and on antiretroviral therapy (100%). End of treatment outcomes included cure (63%), TB culture conversion (83%), completion (0.7%), loss to follow-up (15%), treatment failure (5%), and death (17%). Compared to historic controls (n = 105), patients treated with BDQ experienced significantly higher TB culture conversion and cure, with significantly lower mortality. Adverse effects were common (92%), and most frequently attributed to LZD (24.1%). QT segment prolongation was common but without clinical sequelae.CONCLUSION: Treatment with BDQ- and LZD-containing regimens was associated with improved treatment outcomes and survival in DR-TB HIV patients.


Subject(s)
Coinfection , HIV Infections , Tuberculosis, Multidrug-Resistant , Adult , Antitubercular Agents/therapeutic use , Coinfection/drug therapy , Diarylquinolines , Female , HIV Infections/complications , HIV Infections/drug therapy , Humans , Linezolid , Male , Retrospective Studies , South Africa , Treatment Outcome , Tuberculosis, Multidrug-Resistant/drug therapy
2.
Int J Tuberc Lung Dis ; 24(10): 1073-1080, 2020 10 01.
Article in English | MEDLINE | ID: mdl-33126942

ABSTRACT

Worldwide uptake of new drugs in the treatment of rifampicin-resistant tuberculosis (RR-TB) has been extremely low. In June 2018, ahead of the release of the updated WHO guidelines for the management of RR-TB, South Africa announced that bedaquiline (BDQ) would be provided to virtually all RR-TB patients on shorter or longer regimens. South Africa has been the global leader in accessing BDQ for patients with RR-TB, who now represent 60% of the global BDQ cohort. The use of BDQ within a shorter modified regimen has generated the programmatic data underpinning the most recent change in WHO guidelines endorsing a shorter, injectable-free regimen. Progressive policies on access to new drugs have resulted in improved favourable outcomes and a reduction in mortality among RR-TB patients in South Africa. This supported global policy change. The strategies underpinning these bold actions include close collaboration between the South African National TB Programme and partners, introduction of new TB diagnostic tools in closely monitored conditions and the use of locally generated programmatic evidence to inform country policy changes. In this paper, we summarise a decade´s work that led to the bold decision to use a modified, short, injectable-free regimen with BDQ and linezolid under carefully monitored programmatic conditions.


Subject(s)
Antitubercular Agents , Tuberculosis, Multidrug-Resistant , Antitubercular Agents/therapeutic use , Cohort Studies , Humans , Linezolid , South Africa/epidemiology , Tuberculosis, Multidrug-Resistant/drug therapy
3.
Int J Tuberc Lung Dis ; 22(1): 40-46, 2018 01 01.
Article in English | MEDLINE | ID: mdl-29297424

ABSTRACT

SETTING: Referral hospital for drug-resistant tuberculosis (TB) in KwaZulu-Natal, South Africa. OBJECTIVES: We conducted interviews with primary care givers of children admitted with multidrug-resistant TB (MDR-TB) during a 3-month period in 2015 to identify broader household challenges. RESULTS: We interviewed 26 care givers, most of whom were women (85%). Most households had been decimated by TB/MDR-TB and human immunodeficiency virus (HIV) infection, and were dependent upon government grants. In 54% of cases, parents were absent due to illness or death, or their whereabouts were not known. The median age of the children treated for MDR-TB was 8 years (range 2-14); 72% were HIV-co-infected. Four themes emerged in the interviews: 1) the psychosocial impact of hospitalisation and separation on the child and the household, 2) the psychosocial impact of MDR-TB on children and 3) on care givers, and 4) the economic hardship of affected households. Children had to contend with multiple diseases and medications, and personal family losses; they faced behavioural, emotional and cognitive difficulties. Care givers were often anxious and concerned about the child's longer-term prospects, while the cost of hospital visits exacerbated the pre-existing economic vulnerability of affected households. CONCLUSION: The socio-economic impact of childhood MDR-TB reverberates beyond diseased children to their affected households. Enhanced social protection, psychosocial support and treatment literacy would create the foundations for family-centred care.


Subject(s)
Caregivers/statistics & numerical data , HIV Infections/epidemiology , Social Support , Tuberculosis, Multidrug-Resistant/epidemiology , Adolescent , Caregivers/psychology , Child , Child, Preschool , Coinfection , Family Health/statistics & numerical data , Female , Hospital Costs , Hospitalization/statistics & numerical data , Humans , Interviews as Topic , Male , Parents/psychology , Socioeconomic Factors , South Africa/epidemiology , Tuberculosis, Multidrug-Resistant/economics , Tuberculosis, Multidrug-Resistant/psychology
4.
Int J Tuberc Lung Dis ; 21(5): 556-563, 2017 05 01.
Article in English | MEDLINE | ID: mdl-28399971

ABSTRACT

SETTING: Referral hospital for drug-resistant tuberculosis (DR-TB) in KwaZulu-Natal Province, South Africa. OBJECTIVE: To review the clinical outcomes of patients (age  14 years) with a laboratory-confirmed diagnosis of DR-TB who had minimal symptoms and/or did not have chest radiographic evidence of active disease at referral. These patients were not started on treatment, but were enrolled in an observation programme with follow-up at 2, 6 and 12 months. RESULTS: Of 3345 referred patients diagnosed with DR-TB, 192 (6%) were enrolled in the observation programme. The median duration from initial sputum collection in primary care to examination at our hospital was 92 days (IQR 64-124). After 12 months, 120 (62%) patients were well, 36 (19%) were lost to follow-up, 30 (16%) had deteriorated and were started on second-line anti-tuberculosis treatment and 6 (3%) had died. Bilateral disease (OR 4.25, 95%CI 1.14-15.77, P = 0.030) and previous TB (OR 2.14, 95%CI 1.10-4.19, P = 0.026) were independent predictors of an unfavourable end result in a multivariate model. CONCLUSION: In our high-burden setting, most patients diagnosed with DR-TB who had minimal symptoms at referral remained well without treatment. Longitudinal observation, coupled with symptom checking and chest radiograph, is a viable strategy.


Subject(s)
Sputum/microbiology , Tuberculosis, Multidrug-Resistant/therapy , Watchful Waiting/methods , Adult , Female , Follow-Up Studies , Humans , Longitudinal Studies , Lost to Follow-Up , Male , Multivariate Analysis , Primary Health Care , Referral and Consultation , South Africa , Time Factors
5.
Int J Tuberc Lung Dis ; 20(7): 985-7, 2016 07.
Article in English | MEDLINE | ID: mdl-27287655

ABSTRACT

New drugs offer options for patients with drug-resistant tuberculosis (DR-TB). We describe four individuals with DR-TB in KwaZulu-Natal, South Africa, with prior exposure to clofazimine who would benefit from access to delamanid (DLM). Without DLM, individual options are limited, and there is a risk of resistance amplification and both community and nosocomial spread of DR-TB.


Subject(s)
Antitubercular Agents/therapeutic use , Drug Resistance, Multiple, Bacterial , Extensively Drug-Resistant Tuberculosis/drug therapy , Nitroimidazoles/therapeutic use , Oxazoles/therapeutic use , Tuberculosis, Multidrug-Resistant/drug therapy , Adult , Drug Therapy, Combination , Extensively Drug-Resistant Tuberculosis/diagnosis , Extensively Drug-Resistant Tuberculosis/microbiology , Female , Health Services Accessibility , Humans , Male , South Africa , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/microbiology , Young Adult
6.
Int J Tuberc Lung Dis ; 20(4): 442-7, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26970151

ABSTRACT

SETTING: An urban out-patient clinic in Durban, South Africa, providing community-based treatment for drug-resistant tuberculosis (TB). OBJECTIVE: To describe concordance between patient report and clinician documentation of adverse drug reactions (ADRs) to treatment for multidrug-resistant TB (MDR-TB). DESIGN: ADRs were documented by interview using an 18-item symptom checklist and medical record data abstraction during a cross-sectional parent study with 121 MDR-TB patients, 75% of whom were co-infected with the human immunodeficiency virus. Concordance was analyzed using Cohen's κ statistic, Gwet's agreement coefficient (AC) 1, and McNemar's test. RESULTS: ADRs were reported much more frequently in patient interviews (µ = 8.6) than in medical records (µ = 1.4). Insomnia was most common (67% vs. 2%), followed by peripheral neuropathy (65% vs. 18%), and confusion (61 vs. 4%). κ scores were very low, with the highest degree of concordance found in hearing loss (κ = 0.23), which was the only ADR not found to be significantly different between the two data sources (P = 0.34). CONCLUSIONS: Our study showed a lack of concordance between patient report and clinician documentation of ADRs. These findings indicate the need for improved documentation of ADRs to better reflect patients' experiences during MDR-TB treatment. These data have important implications for country-level pharmacovigilance programs that rely on clinician documentation of ADRs for MDR-TB policy formation.


Subject(s)
Antitubercular Agents/adverse effects , Tuberculosis, Multidrug-Resistant/drug therapy , Adolescent , Adult , Antitubercular Agents/therapeutic use , Coinfection/drug therapy , Confusion/chemically induced , Confusion/physiopathology , Cross-Sectional Studies , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Outpatients , Peripheral Nervous System Diseases/chemically induced , Peripheral Nervous System Diseases/physiopathology , Sleep Initiation and Maintenance Disorders/chemically induced , Sleep Initiation and Maintenance Disorders/physiopathology , South Africa , Young Adult
7.
Int J Tuberc Lung Dis ; 19(2): 163-71, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25574914

ABSTRACT

SETTING: KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE: To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. DESIGN: A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation. RESULTS: Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites. CONCLUSION: Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.


Subject(s)
Antitubercular Agents/therapeutic use , Community Health Services/organization & administration , Hospitalization , Tuberculosis, Multidrug-Resistant/drug therapy , Adult , Anti-HIV Agents/therapeutic use , Cohort Studies , Female , HIV Infections/complications , HIV Infections/drug therapy , Health Services Accessibility , Home Care Services/organization & administration , Humans , Male , Models, Theoretical , Prospective Studies , South Africa , Treatment Outcome
8.
J Intern Med ; 277(4): 388-405, 2015 Apr.
Article in English | MEDLINE | ID: mdl-24809736

ABSTRACT

The first cases of totally drug-resistant (TDR) tuberculosis (TB) were reported in Italy 10 years ago; more recently, cases have also been reported in Iran, India and South Africa. Although there is no consensus on terminology, it is most commonly described as 'resistance to all first- and second-line drugs used to treat TB'. Mycobacterium tuberculosis (M.tb) acquires drug resistance mutations in a sequential fashion under suboptimal drug pressure due to monotherapy, inadequate dosing, treatment interruptions and drug interactions. The treatment of TDR-TB includes antibiotics with disputed or minimal effectiveness against M.tb, and the fatality rate is high. Comorbidities such as diabetes and infection with human immunodeficiency virus further impact on TB treatment options and survival rates. Several new drug candidates with novel modes of action are under late-stage clinical evaluation (e.g., delamanid, bedaquiline, SQ109 and sutezolid). 'Repurposed' antibiotics have also recently been included in the treatment of extensively drug resistant TB. However, because of mutations in M.tb, drugs will not provide a cure for TB in the long term. Adjunct TB therapies, including therapeutic vaccines, vitamin supplementation and/or repurposing of drugs targeting biologically and clinically relevant molecular pathways, may achieve better clinical outcomes in combination with standard chemotherapy. Here, we review broader perspectives of drug resistance in TB and potential adjunct treatment options.


Subject(s)
Extensively Drug-Resistant Tuberculosis/therapy , Drug Resistance, Bacterial/genetics , Extensively Drug-Resistant Tuberculosis/diagnosis , Extensively Drug-Resistant Tuberculosis/epidemiology , Extensively Drug-Resistant Tuberculosis/etiology , Extensively Drug-Resistant Tuberculosis/immunology , Genotype , Global Health , Host-Pathogen Interactions , Humans , Mutation , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/physiology , Nitroimidazoles/therapeutic use , Oxazolidinones/therapeutic use
9.
J Antimicrob Chemother ; 69(11): 3103-7, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24986495

ABSTRACT

BACKGROUND: Extensively drug-resistant (XDR) tuberculosis (TB) and HIV coinfection is associated with low cure rates and high mortality. Clofazimine has shown activity in vitro against Mycobacterium tuberculosis, but clinical experience with clofazimine in XDR-TB and HIV coinfection is limited. METHODS: This was a retrospective cohort study of adult XDR-TB patients in KwaZulu-Natal, South Africa, treated with either a clofazimine- or non-clofazimine-containing XDR-TB treatment regimen. The primary outcome measure was TB culture conversion at 6 months. Survival analysis and multivariate logistic regression compared time to event in different strata and identified risk factors for TB culture conversion. RESULTS: Between August 2009 and July 2011, eligible XDR-TB patients (n = 85) were initiated on treatment for XDR-TB. Most patients (86%) were HIV-infected and receiving antiretroviral therapy (90%). Patients receiving a clofazimine-containing regimen (n = 50) had a higher percentage of culture conversion (40%) compared with patients (n = 35) receiving a non-clofazimine regimen (28.6%). On multivariate analysis, there was a 2-fold increase in TB culture conversion at 6 months (hazard rate ratio 2.54, 95% CI 0.99-6.52, P = 0.05) in the group receiving a clofazimine-containing regimen. Adverse effects due to clofazimine were minor and rarely life-threatening. CONCLUSIONS: Clofazimine was associated with improved culture conversion in the treatment of XDR-TB/HIV. Adverse effects were minor and non-life-threatening. Based on these preliminary data, further study of clofazimine in XDR-TB/HIV treatment is warranted. Given the present low rates of culture conversion in XDR-TB treatment, we recommend empirical inclusion of clofazimine in treatment regimens for XDR-TB.


Subject(s)
Clofazimine/therapeutic use , Extensively Drug-Resistant Tuberculosis/drug therapy , Extensively Drug-Resistant Tuberculosis/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , Adult , Antitubercular Agents/therapeutic use , Cohort Studies , Coinfection , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , South Africa/epidemiology , Treatment Outcome
10.
S Afr Med J ; 104(3): 164-6, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24897814

ABSTRACT

While clinical disease caused by drug-sensitive Mycobacterium tuberculosis (MTB) can usually be treated successfully, clinical disease caused by drug-insensitive MTB is associated with a poorer prognosis. In December 2012, a new drug, bedaquiline, was approved by the US Food and Drug Administration. This article documents the process whereby the National Department of Health, Right to Care and Médecins Sans Frontières obtained access to this medication for South Africans who might benefit from subsequent implementation of the Clinical Access to Bedaquiline Programme.


Subject(s)
Diarylquinolines/therapeutic use , Tuberculosis, Multidrug-Resistant/drug therapy , Health Services Accessibility/trends , Humans , South Africa
11.
Int J Tuberc Lung Dis ; 16(2): 209-15, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22236922

ABSTRACT

SETTING: In KwaZulu-Natal, South Africa, a setting endemic for tuberculosis (TB) and the human immunodeficiency virus (HIV), prolonged hospitalisation for the treatment of the growing number of multidrug-resistant TB (MDR-TB) patients is neither possible nor effective. OBJECTIVE: To compare early treatment outcomes in patients with MDR-TB with and without HIV co-infection at four decentralised rural sites with a central urban referral hospital. DESIGN: This is an operational, prospective cohort study of patients between 1 July 2008 and 30 November 2009, where culture conversion, time to culture conversion, survival and predictors of these outcomes were analysed. RESULTS: Of 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected. In the 17-month study period, there was a higher proportion of culture conversion at the decentralised sites compared with the centralised hospital (54% vs. 24%, P < 0.001, OR 3.76, 95%CI 2.81-5.03). The median time to treatment initiation was significantly shorter at the decentralised sites compared with the centralised hospital (72 vs. 93 days, P < 0.001). There was no significant difference in survival following treatment initiation. CONCLUSION: In this study, early treatment outcomes suggest that decentralised care for MDR-TB patients is superior to that in a centralised setting.


Subject(s)
Antitubercular Agents/therapeutic use , Delivery of Health Care, Integrated/methods , Health Services Accessibility , Hospitalization , Hospitals, District , Tuberculosis, Multidrug-Resistant/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morbidity/trends , Prospective Studies , South Africa/epidemiology , Time Factors , Tuberculosis, Multidrug-Resistant/epidemiology , Young Adult
12.
Int J Tuberc Lung Dis ; 14(4): 420-6, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20202299

ABSTRACT

SETTING: Hlabisa health sub-district, KwaZulu-Natal, South Africa. OBJECTIVE: To describe the establishment of a community-based multidrug-resistant tuberculosis (MDR-TB) treatment programme embedded in the district TB control programme and to evaluate whether early outcomes are comparable to those in the traditional hospital-based model of care. DESIGN: Cases who initiated community-based MDR-TB treatment (CM) between March and December 2008 were compared with patients who initiated MDR-TB treatment under the traditional hospital-based model of care (TM) between January 2001 and February 2008. Time to initiation of treatment and time to sputum smear and culture conversion were compared for the two groups in Kaplan-Meier survival curves using the Mantel-Cox log-rank test. RESULTS: Overall, 50 CM cases and 57 TM cases were included; 39 of the 50 CM cases (78.0%) were human immunodeficiency virus positive. The median time to initiation of treatment was 84 days for CM and 106.5 days for TM (P = 0.002). Median time to sputum smear conversion was shorter for CM than TM (59 vs. 92 days, P = 0.055), as was time to sputum culture conversion (85 vs. 119 days, P = 0.002). CONCLUSION: Community-based treatment for MDR-TB can be implemented within the existing TB control programme in rural South Africa and should be scaled up where resources allow.


Subject(s)
Antitubercular Agents/therapeutic use , Community Health Services/organization & administration , Delivery of Health Care, Integrated/organization & administration , Health Services Accessibility/organization & administration , Rural Health Services/organization & administration , Tuberculosis, Multidrug-Resistant/drug therapy , Chi-Square Distribution , Developing Countries , Female , HIV Infections/epidemiology , Home Care Services, Hospital-Based/organization & administration , Hospitalization , Hospitals, District/organization & administration , Humans , Kaplan-Meier Estimate , Male , Outpatient Clinics, Hospital/organization & administration , Program Development , Program Evaluation , Proportional Hazards Models , Retrospective Studies , South Africa/epidemiology , Sputum/microbiology , Time Factors , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/mortality
13.
Int J Tuberc Lung Dis ; 13(7): 855-61, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19555535

ABSTRACT

SETTING: A public tuberculosis (TB) referral hospital in KwaZulu-Natal, South Africa. OBJECTIVE: To present treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) patients and human immunodeficiency virus (HIV) coinfection with and without highly active antiretroviral therapy. METHODS: Retrospective cohort study. Eligible patients had drug susceptibility testing that met a consensus definition for XDR-TB, and agreed to treatment. Therapy was based on drug susceptibilities, available medications and patient tolerance. RESULTS: Overall, 60 XDR-TB patients initiated therapy with a median number of 5.5 drugs. Of these, 43 (72%) were HIV-positive, and 21 (49%) were on antiretroviral therapy; 29 HIV-infected patients (67%) had available CD4 counts, with a median CD4 count of 200.5 cells/mm(3) (standard deviation 127.4 cells/mm(3)). Of 60 patients, 31 (52%) had adverse events (AEs), and 17/60 patients (28%) had severe AEs. During follow-up, 12/60 (20%) experienced sputum culture conversion, while 25/60 (42%) patients died. None of the following was significantly associated with mortality: HIV status, previous MDR diagnosis or severe AEs. DISCUSSION: In this study, it was possible to treat HIV-XDR-TB coinfected patients and prolong survival in a resource-limited setting. We highlight the challenges in treatment, including high frequencies of AEs and death. Expanded identification of cases, prompt referral for treatment, and attention to management of comorbidities may facilitate successful treatment of XDR-TB in HIV-infected patients.


Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antiretroviral Therapy, Highly Active , Antitubercular Agents/therapeutic use , HIV Infections/complications , HIV-1 , Tuberculosis, Multidrug-Resistant/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Adult , Female , HIV Infections/epidemiology , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Proportional Hazards Models , Retrospective Studies , South Africa/epidemiology , Treatment Outcome , Tuberculosis, Multidrug-Resistant/epidemiology
14.
J Pediatr ; 118(3): 347-53, 1991 Mar.
Article in English | MEDLINE | ID: mdl-1671878

ABSTRACT

Most infants with pediatric acquired immunodeficiency syndrome and infections with human immunodeficiency virus type 1 (HIV-1) are infected perinatally by their mothers. To determine the proportion of exposed infants who are infected, we conducted a hospital-based prospective study in HIV-1-infected women whose infants were delivered at a single metropolitan hospital in Miami, Fla. A population of uninfected women and their infants was also enrolled and followed longitudinally for 2 years to assess laboratory and clinical measurements. The median follow-up is now 18 months for 82 infants born to HIV-1-infected mothers. The proportion of infected infants in this group is 0.30 (25/82). None of the infants born to 110 HIV-1-seronegative mothers were seropositive. Infected infants were easily distinguished from noninfected infants by virus isolation. No single immunologic or hematologic measure was predictive of infection for all infants at risk for HIV-1 infection who were 6 months of age or younger. As a group, however, infected infants could be distinguished from uninfected index infants by a number of immunologic measures by 6 months of age; the absolute number of CD4+ lymphocytes and the CD4+/CD8+ lymphocyte ratio were the variables most predictive of infection. As in retrospective studies, clinical disease developed in 80% of infected infants within the first 24 months of life. This study provides documentation of HIV-1 perinatal transmission risk and early correlates of infection in young infants from a single hospital.


Subject(s)
Acquired Immunodeficiency Syndrome/congenital , HIV-1 , Acquired Immunodeficiency Syndrome/transmission , CD4-Positive T-Lymphocytes/pathology , Child, Preschool , Female , Florida , Follow-Up Studies , HIV Antibodies/analysis , HIV Seropositivity , HIV-1/immunology , HIV-1/isolation & purification , Haiti/ethnology , Humans , Immunoglobulin A/analysis , Infant , Infant, Newborn , Leukocyte Count , Lymphocyte Subsets/pathology , Male , Maternal-Fetal Exchange , Pregnancy , Prospective Studies , Risk Factors , T-Lymphocytes, Regulatory/pathology
15.
Arch Environ Contam Toxicol ; 10(4): 427-35, 1981 Jul.
Article in English | MEDLINE | ID: mdl-7259306

ABSTRACT

The effects of 24 to 72-hr exposure to fenthion (10(1)-10(3) ppb) were determined for a fungal community, nitrogen-fixing microbes, and representative meiofaunal and zooplankton invertebrates of a mangrove ecosystem. Also tested were the abilities of a benthic diatom and of fungi to grow in the presence of fenthion. Acute lethal, growth-inhibiting, or process-disrupting effects were not detected for exposures to less than 500 ppb fenthion. Results are compared with the findings of several other investigations of the impact of fenthion and other organophosphorus insecticides on non-target organisms.


Subject(s)
Bacteria/drug effects , Fungi/drug effects , Insecticides/toxicity , Plankton/drug effects , Animals , Ecology , Eukaryota/drug effects , Fenthion/toxicity
16.
Talanta ; 25(7): 423-4, 1978 Jul.
Article in English | MEDLINE | ID: mdl-18962293
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