Evaluating the contribution of APOBEC3G haplotypes, on influencing HIV infection in a Zimbabwean paediatric population.

BACKGROUND: Apolipoprotein B mRNA-editing catalytic polypeptide like-3G (APOBEC3G) is an antiviral enzyme that reduces viral fitness by introducing uracil to thymidine hypermutations in viral genomes. Thus, polymorphisms in the APOBEC3G gene have been implicated in differential outcomes of HIV infection and disease progression. However, there is insufficient evidence on the role of APOBEC3G gene variants on HIV infection, especially in African populations. This study therefore describes polymorphisms in the APOBEC3G gene in a Zimbabwean paediatric population and evaluates their effects on susceptibility to HIV infection among children born to HIV-infected mothers. Methods. A total of 104 children aged between 7 and 9 years, comprising 68 perinatally exposed to HIV (32 born infected (EI) and 36 born uninfected (EU)) and 36 unexposed and uninfected (UEUI) controls were recruited. Allelic variants (n=5) in the APOBEC3G gene were characterised. Results. Frequencies for minor APOBEC3G alleles in the HIV-uninfected groups (EU and UEUI) were c.557G (40%), g.-90C (32%), g.-571C (12%), c.467-85C (42%), and c.582-162G (6%). APOBEC3G c.467-85C frequency was statistically significantly different when compared to the Masai of Kinyawa, Kenya population (42% v. 18%). None of the single nucleotide polymorphisms individually or as part of haplotypes were significantly associated with HIV infection when comparing the EI and EU groups. Conclusions. Our findings suggest that APOBEC3G polymorphisms alone may not have significant predictive power for inferring genetic susceptibility to vertical transmission of HIV in children perinatally exposed to HIV.

Clinical laboratory test prices in Zimbabwe: A case of profiteering?

OBJECTIVE: To compare the prices charged for clinical laboratory tests in Zimbabwean institutions with those of similar institutions abroad. DESIGN: An online analytical cross sectional study was conducted. SETTING: An online survey. SUBJECTS: We did an online survey of clinical laboratories that published prices of the tests offered on their websites. We also extracted price information from documents published by fees regulatory authorities. MAIN OUTCOME MEASURES: Laboratory test prices for independent institutions, Laboratory test prices for State institutions. RESULTS: Overally for all countries, laboratory test prices were lower in state laboratories compared to the independent laboratories. In Zimbabwe, state laboratories generally charged about 50% of the independent laboratory tariff for most tests. However prices from both Zimbabwean institutions were generally much higher than those of the comparison countries (United Kingdom, South Africa, India, United States of America and New Zealand). CONCLUSION: Prices of laboratory tests are indeed higher in Zimbabwean institutions compared to other centres abroad. These higher prices could be attributed to challenges in consumable procurement logistics. We also present measures that could be put in place to reduce the costs and therefore prices.

Investigation of the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare, Zimbabwe.

MAIN OBJECTIVE: To evaluate the effect of Stalanev (Stavudine, Lamivudine and Nevirapine) treatment on plasma lactate levels in adults attending Beatrice Road Infectious Diseases Hospital and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare. DESIGN: Prospective cohort study carried out between January and May 2011. SETTING: Beatrice Road and Wilkins Infectious Diseases Hospital Opportunistic Infections Clinics in Harare, Zimbabwe. PARTICIPANTS: A convenience sample of 180 ART naive HIV infected adults aged 20-68 years who were about to be initiated on STALANEV were recruited. RESULTS: The mean plasma lactate at baseline was 1.57 mmol/L (SD 0.43). After two months on STALANEV, 25 participants (13.9%) had hyperlactatemia and the mean plasma lactate level was 1.99 mmol/L (SD 0.49). At four months follow up, 98 participants (54%) had hyperlactatemia and the mean plasma lactate level was 2.65 mmol/l (SD 0.55). Mean plasma lactate levels increased significantly from baseline to 2 months follow up and from 2 months follow up to 4 months follow up (p < 0.001). None of the participants developed lactic acidosis (plasma lactate > 3.5) after two months of follow up but 14 (7.8%) developed mild lactic acidosis and three (1.7%) had moderate lactic acidosis after four months on STALANEV. CONCLUSIONS: Our findings are in agreement with those of other studies that reported that treatment with STALANEV leads to hyperlactatemia thereby posing a risk for the development of lactic acidosis in patients. In the absence of alternative regimens, we recommend routine monitoring of plasma lactate levels on all patients on STALANEV in Zimbabwe.

Evaluation of cost per test of clinical biochemistry tests at Parirenyatwa Central Hospital Laboratory, Harare, Zimbabwe.

OBJECTIVES: To determine the cost per test for selected clinical biochemistry tests at Parirenyatwa Central Hospital, Harare, Zimbabwe. DESIGN: A retrospective study for the month January 2003. Cost analysis was based on a 'bottom-up' micro cost analysis technique. SETTING: Parirenyatwa Central Hospital Laboratory. RESULTS: There was wide variation between the cost of performing a test and the hospital fee schedule offered in payment. The greatest variation was obtained for low frequency tests and direct consumables accounted for 61.2% ofthe total costs. CONCLUSION: Laboratory tests are heavily subsidized and there is need to contain the escalating costs by adopting some aggressive cost recovery measures. Introduction of systematic teaching of health economics in the colleges of health sciences is also advocated.