AIDS pandemic hits women harder yet prevention strategies lag behind.

PIP: One-timed of all individuals infected with HIV are women; the proportion of women infected will grow to 50% by the year 2000. 25% of children born to HIV-infected mothers are infected with HIV. These statistics suggest that countries must prepare for the growing tide of orphans and an expected increase in infant and child deaths due to AIDS of up to 50% over the 1990s. Prevention and control programs encourage reducing the number of sex partners, using condoms, and controlling sexually transmitted diseases (STD). Many women in developing countries, however, remain at risk for HIV infection since economic conditions necessitate that they have paid sexual relations with multiple partners for economic survival. Further, married women who engage in sexual relations with only their spouse may still be at risk for infection if the spouse enjoys sex with other partners. It must also be understood that men tend to control condom use; women have many asymptomatic STDs; and women may be stigmatized for seeking treatment at a clinic. Women must participate collectively and help develop and implement prevention strategies designed to increase their degree of empowerment and reduce their risk of exposure to HIV and AIDS.^ieng

Sequence analysis of selected regions of the env (V3 loop and gp41) and gag (p7) reading frames of Ethiopian human immunodeficiency virus type 1 strains.

Amplified polymerase chain reaction (PCR) products, corresponding to the V3 loop and gp41 of the env, and p7 of the gag region, from proviral DNA of several Ethiopian and Swedish HIV-1 strains were sequenced. Of the six amino acids (GPGRAF) that constitute the principal neutralizing determinant (PND) within the V3 loop, the Ethiopian isolates all showed two amino acid changes (GPGQTF). Four to five other substitutions were found in the amino acids flanking the PND. Substitution of alanine (A) for threonine (T) should result in a change in the predicted secondary structure, i.e., disappearance of a coil structure. Percentage similarity data on a stretch of 22 amino acids within the V3 loop showed a concordance of the Ethiopian HIV-1 isolates with the sequences of published macrophage-T-cell tropic HIV isolates. Additionally derived protein sequences in two other regions showed two common substitutions in p7 and one to two substitutions in gp41 compared to a recent consensus sequence. These changes are hitherto unique for the Ethiopian strains, and suggest the presence of a clustering of a divergent HIV-1 strain in Addis Ababa, Ethiopia.

Raised levels of tumour necrosis factor-alpha and neopterin, but not interferon-alpha, in serum of HIV-1-infected patients from Ethiopia.

Serum levels of tumour necrosis factor-alpha (TNF-alpha), neopterin and interferon-alpha (IFN-alpha) were determined by immunoradiometric assays in 60 HIV-1+ and 20 HIV-1- subjects from Ethiopia. Swedish samples were used as reference material. The Ethiopian HIV-1+ subjects were found to have significantly increased TNF-alpha and neopterin, but not IFN-alpha levels. Increased levels of TNF-alpha and neopterin were frequently found in Ethiopian asymptomatic subjects (37% and 47%), and the concentration increased in patients with AIDS (83% and 90% respectively). The levels of the two substances and the proportion of patients with higher TNF-alpha values were lower in the corresponding Swedish subjects. The proportion of sera with raised levels of IFN-alpha was very low (asymptomatic 4%, and AIDS 7%) in Ethiopian subjects. These results suggest a very early increase in the TNF-alpha production and activation of the cellular immune response, and a low level of IFN-alpha synthesis in the natural course of HIV infection in Ethiopia. The aberrations may contribute to a rapid progress of immunodeficiency and cachexia often seen in Ethiopian patients.

Relationship between cell-free viraemia, antigenaemia and antibody levels in HIV-1-infected Ethiopian patients.

OBJECTIVE: To determine the relationship and occurrence of cell-free viraemia, free or immune-complexed p24-antigen and p24-antibody levels in blood from HIV-1-infected patients in Ethiopia. METHODS: Peripheral blood was obtained from 66 Ethiopian and 137 Swedish HIV-1-seropositive patients. Blood samples were analysed for free or immune-complex bound p24 antigen by enzyme-linked immunosorbent assay before and after acid hydrolysis of immune complexes for infectious virus in plasma and peripheral blood mononuclear cells (PBMC), and for p24-antibody levels. We compared the kinetics of viral replication of Ethiopian with Swedish isolates in vitro. RESULTS: Infectious virus was isolated from PBMC in 95% and from plasma in 81% of Ethiopian AIDS patients. In contrast, p24 antigen was detected in only 5% of AIDS patients from Ethiopia, compared with 76% of those from Sweden. p24-antibody levels were much higher and more persistent in Ethiopian than in Swedish subjects. The ratio between reverse transcriptase activity and p24 antigen was significantly higher in Ethiopian isolate culture than in those of the Swedish isolates. CONCLUSIONS: Our results show that relationships between viraemia, p24 antigenaemia and p24-antibody levels in HIV-1-infected Ethiopian patients differ from those found in comparable Swedish patients. This pattern may partly explain the differences seen in the natural course of HIV-1 infection in Ethiopia and Sweden.

PIP: Researchers conducted hematologic tests on 66 HIV-1 positive adults from Ethiopia and compared the results with those of 137 HIV-1 patients in Stockholm, Sweden, to determine the incidence of cell-free viremia, free or complexed p24 antigen, and p24 antibody levels. They isolated HIV-1 from peripheral blood mononuclear cells in 95% and from plasma in 81% of the Ethiopian subjects. The corresponding percentages for the Swedish subjects were 95% and 92%. They found p24 antigen in only 5% of AIDS patients from Ethiopia (none for asymptomatic HIV-1 subjects) compared with 76% of Swedish patients (p .01). The Ethiopian subjects had significantly higher p24 antibody levels than did the Swedish subjects (85% vs. 52%; p = .008). The ratio between reverse transcriptase activity and p24 antigen concentration stood much higher in the Ethiopians than in the Swedes (7.5 vs. 3.6; p = .0019). These results suggested that the HIV-1 strains in the Ethiopian subjects resembled rapid high HIV-1 strains. In addition, the high degrees of cell-free viremia, relative lack of free or immune complexed p24 antigen, and a persistence of p24 antibody during the entire course of infection in Ethiopian HIV-1 infected subjects intimated that the interaction between HIV-1 and the Ethiopians may be different in Africa than it is in Europe and North America. The results of another study conducted by the researchers supported this conclusion. They included high levels of tumor necrosis factor-alpha and neopterin and low levels of interferon-alpha in HIV-1 positive Ethiopians.

HIV infection in Ethiopian blood donors : prevalence; trends and future projections

The study was designed to assess the prevalence and geographic distribution of human immunodeficiency virus type 1 (HIV-1) infection in Ethiopian blood donors and to evaluate trends as well as make short term predictions on the growth of the epidemic. Donor HIV-1 screening results of six Ethiopian Red Cross Society (ERCS) blood banks; between October 1987 and September 1991; were analyzed. Repeat positivity rates in the Enzyme Linked Immune Sorbent Assay (ELISA) obtained using two different generations of welcozyme test kits were converted to confirmed western blot positivity rates in accordance with test specificities of two generation test kits obtained in low risk population locally. Trend analysis in Addis Ababa donors was made by fitting an appropriate curve to observed prevalence rates; which was used to make short term projections. During the study period; the blood screening component of the AIDS control programme was able to effectively prevent the transfusion of 3291 in HIV-1 infected blood. On the other hand a progressive increment and wide variation in HIV-1 prevalence rates of 0-5.2 per cent in 1988 and 1.6-11.6 per cent in 1991 was obtained. The overall M:F sex ratio was 1:07. The HIV-1 epidemic followed a simple exponential growth curve and the prevalence rate in Addis Ababa donors by the end of 1992 is expected to be 7.9 per cent. These data show that HIV-1 epidemic in Ethiopian blood donors are in their exponential growth phase and donor screening mechanisms utilized by our transfusion centers are effective but need to be improved significantly to screen out high risk donors. The establishment of more effective measures for the prevention and control of HIV-1 infection in general and blood safety in particular is recommended

HIV-1 in Ethiopia: phylogenetic divergence from other HIV-1 strains.

Phylogenetic tree analysis was performed on selected polymerase chain reaction (PCR)-amplified and sequenced regions of the gag and env reading frames of several Ethiopian and Swedish human immunodeficiency virus type 1 (HIV-1) strains. These regions are considered to be conserved parts of the HIV-1 genome and correspond to the p7 of the core (gag) and part of the carboxy terminal of the gp41 protein of env respectively. Comparisons were made with all available HIV-1 sequences. The tree analysis showed that gag sequences from nine and env sequences from four Ethiopian strains all grouped together in separate branches distinct from all other sequenced European, North American, and African HIV-1 isolates. Thus, the Ethiopian strains seem to represent a highly divergent group of HIV-1, which might have developed during a relatively early stage of HIV-1 evolution.

Differences in PCR reactivity between HIV proviruses from individuals in Ethiopia and Sweden.

The polymerase chain reaction (PCR), using primer pairs in the gag, pol, and env regions, was used in a comparative study of HIV-1 DNA in peripheral mononuclear blood cells from HIV-1-seropositive individuals in Ethiopia and Sweden. Although all Swedish samples were positive by PCR, the reactivity was more pronounced in samples from late stages than in those from early stages of infection. Six of nine Ethiopian samples from HIV-1-seropositive patients were positive by PCR, but the reactions were much weaker than those observed for Swedish samples, and in most cases seen with one primer pair only. These results suggest that the burden of HIV-1 DNA in peripheral mononuclear blood cells increases with advancing disease. PCR using primer pairs designed to detect HIV-1 infection in Europe and North America is not always suitable for the detection of HIV-1 infection in Ethiopia. The differences in PCR reactivity could possibly be a consequence of differences regarding host responses to the virus in the two countries, but more likely due to genomic differences between HIV-1 strains prevalent in Ethiopia and Sweden.

HIV seropositivity in a 40-day-old child in Addis Ababa.

In this communication Human Immunodeficiency Virus (HIV) seropositivity is described in a 40-day-old Ethiopian child born to parents infected with HIV-I.

Acquired immunodeficiency syndrome: seven cases in an Addis Ababa hospital.

PIP: 7 confirmed cases of Acquired Immune Deficiency Syndrome (AIDS), seen in the Department of Medicine, Yekatit 12 Hospital, Addis Ababa, Nigeria, are presented. These are the 1st cases to be reported in Ethiopia. The ELISA and Western Blot tests were performed at the National Research Institute of Health in Addis Ababa. Attempts to trace possible sexual contacts of 3 cases were unsuccessful. Family members of 2 cases were tested for HIV infection. 3 of the 7 patients presented with tuberculosis, 2 with pneumocystis carinii pneumonia, 1 with generalized lymphadenopathy, and 1 with chronic diarrhea. All had AIDS; 6 of the 7 had 2 major clinical criteria, and all had 2 or more minor clinical criteria. 4 of the patients died. The diagnosis of 7 clinically obvious cases within 1 year in 1 general hospital at a time when it was somewhat difficult to have serological tests performed suggests the urgency of education of hospital workers in the safe handling of blood, blood products and body fluids, and through sterilization of needles and other equipment used by and for all patients.^ieng