T follicular helper cells and antibody response to Hepatitis B virus vaccine in HIV-1 infected children receiving ART.

HBV vaccine has 95% efficacy in children to prevent HBV infection and related cancer. We conducted a prospective study in HIV-1 infected children receiving ART (n = 49) and controls (n = 63) to assess humoral and cellular responses to HBV vaccine provided with three doses under an accelerated schedule of 4 weeks apart. At 1 month post-vaccination all children, except 4 HIV-1 infected, displayed protective antibody (ab) titers to HBV vaccine; ab titers were lower in infected children (P < 0.0001). Ab titers decreased (P < 0.0001) in both HIV-1 infected and control children at 6 months. The frequency of circulating Tfh (cTFh) cells was 20.3% for controls and 20.8% for infected children prior to vaccination and remained comparable post-vaccination. Cytokine expression by cTfh cells upon activation with HBV antigen was comparable in the two groups at baseline and 1 month post-vaccination. Higher plasma levels (P < 0.0001) of CXCL13 were found in infected children which correlated with cTfh cell frequency at baseline. In conclusion, a lower ab response to HBV vaccine was measured in HIV-1 infected children. The frequency and activation profile of cTfh cells was comparable in infected children and controls suggesting that cells other than Tfh cells are responsible for impaired ab response to HBV vaccine.

Assessment of antibacterial drug exposure patterns of patient encounters seen by different categories of prescribers at health institutions in Bahir Dar, Ethiopia.

BACKGROUND: Understanding of existing antibacterial drug prescribing patterns is a pre-requisite for further investigation of potential determinants of irrational prescribing, if any, thereby looking for solutions would be easier. OBJECTIVE: This study was conducted to assess antibacterial prescription patterns of different health professionals working at general outpatient clinics of different health institutions. METHODS: In this cross-sectional study, a total of 1558 prescriptions of patient encounters, were collected from four clusters of prescribers randomly selected from 11 public and 15 private health institutions in Bahir Dar town and its environs, North West Ethiopia. RESULTS: A significant proportion of patient encounters were exposed to at least one antibacterial drug with percentage of encounters to whom antibacterial(s) prescribed was 64.5%. Multiple antibacterial drug exposure was minimal (7.8%) with a maximum of 3 antibacterial drugs per encounter. The study showed that patients at pediatric age group were more likely to receive an antibacterial drug than adult counter parts (70.3% vs 62.8%, p = 0.038, OR = 1.33). On the other hand, there were no statistically significant differences in the antibacterial exposure patterns of patients seen by prescribers of shorter pre-service training (health assistants and nurses) and those with longer duration (health officers and general practitioners) and also between patients seen at public and private health institutions. CONCLUSIONS: This study indicates that a significant proportion of patient encounters were exposed to antibacterial drugs. The actual determinants of the existing patterns should be further investigated in order to arrive at clear and feasible strategies to promote rational antibacterial drug prescribing practices.

Delayed clearance of Plasmodium falciparum in patients with human immunodeficiency virus co-infection treated with artemisinin.

We investigated the effect of artemisinin on the rate of clearance of Plasmodium falciparum in patients with or without human immunodeficiency virus (HIV) co-infection. Initial mean (+/- SEM) parasite density was not different between HIV-infected and HIV-uninfected groups (27,486 +/- 2,643 versus 32,892 +/- 6,583, respectively; P = 0.55). The mean (+/- SEM) time to clear 75% and 90% of the parasites was 23.1 hr +/- 1.8 and 29.3 hr +/- 1.9, respectively, for the HIV seropositive patients compared with 16.0 hr +/- 1.4 and 20.8 hr +/- 1.4, respectively for the HIV seronegative patients (P = 0.0075 and 0.0026, respectively). By 32 hr, almost all (6/7) HIV positive patients remained parasitemic in contrast with 2/12 HIV seronegative patients. Moreover, the mean parasite density was almost 12-fold higher in the HIV seropositive patients than in the HIV seronegative patients at the same period (1789 +/- 616 versus 150 +/- 118, respectively; P = 0.0037). Overall, the mean parasite clearance time was 37.7 hr +/- 2.1 in the HIV seropositive group and 30.0 hr +/- 2.1 in those who were HIV seronegative (P = 0.0284). Whereas mean fever clearance time was 40.6 hr +/- 2.4 for the HIV seropositive group, it was 28.7 hr +/- 1.2 for those who were HIV seronegative (P = 0.0001). These observations are compatible with the hypothesis that the host's immunity affects the activity of antimalarial drugs, and our data suggest for the first time that clearance of P. falciparum after administration of artemisinin is delayed in patients with HIV co-infection.