1,115 research outputs found
Zimbabwe: HIV-AIDS Infection At Birth: Far More Common Than Was Thought - 16 March 2010
No full textHealth workers in the developing world may need to test adolescents routinely for HIV acquired "vertically" — through mother-to-child transmission, following findings published in the medical journal; Public Library of Science – Medicine. Nearly half of a group of three hundred patients between the ages of 10 and 18, admitted to hospital in Zimbabwe for any reason, tested positive for HIV. And the absence of herpes simplex infection in the majority of these — along with other factors — clearly indicates that sex was not the principal means of transmission. Rashida Ferrand discusses the findings of her London School of Hygiene and Tropical Medicine team working jointly with the Biomedical Research Institute in Harrare
The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: a systematic review
No full textObjective:HIV-positive children, adolescents, and young adults are at increased risk poor musculoskeletal outcomes. Increased incidence of vitamin D deficiency in youth living with HIV may further adversely affect musculoskeletal health. We investigated the impact of vitamin D supplementation on a range of musculoskeletal outcomes among individuals aged 0–25 years living with HIV.Methods:A systematic review was conducted using databases: PubMed/Medline, CINAHL, Web of Knowledge, and EMBASE. Interventional randomised control trials, quasi-experimental trials, and previous systematic reviews/meta-analyses were included. Outcomes included: BMD, BMC, fracture incidence, muscle strength, linear growth (height-for-age Z-score [HAZ]), and biochemical/endocrine biomarkers including bone turnover markers.Results:Of 497 records, 20 studies met inclusion criteria. Thirteen studies were conducted in North America, one in Asia, two in Europe, and four in Sub-Saharan Africa. High-dose vitamin D supplementation regimens (1,000–7,000 IU/day) were successful in achieving serum 25-hydroxyvitamin-D (25OHD) concentrations above study-defined thresholds. No improvements were observed in BMD, BMC, or in muscle power, force and strength; however, improvements in neuromuscular motor skills were demonstrated. HAZ was unaffected by low-dose (200–400 IU/day) supplementation. A single study found positive effects on HAZ with high-dose supplementation (7,000 vs 4,000IU/day).Conclusions:Measured bone outcomes were unaffected by high-dose vitamin D supplementation, even when target 25OHD measurements were achieved. This may be due to: insufficient sample size, follow-up, intermittent dosing, non-standardised definitions of vitamin D deficiency, or heterogeneity of enrolment criteria pertaining to baseline vitamin D concentration. High-dose vitamin D may improve HAZ and neuromuscular motor skills. Adequately powered trials are needed in settings where HIV burden is greatest
Trailer - Chiedza’s Song: Growing up with HIV in Zimbabwe
No full textThis is a trailer to the film Chiedza's song which looks at the struggles of adolescents growing up with HIV in Zimbabwe. It's a film by Rashida Ferrand, Tom Gibb and Joe Njagu. Supported by the Wellcome Trust.
With advances in treatment and medication, increasing numbers of HIV-infected children are reaching adolescence globally. There is a lack of awareness about the complex socio-cultural issues these children face and many are stigmatised and isolated.
Dr Rashida Ferrand (Department of Clinical Research) an HIV clinical specialist and epidemiologist, has worked with young people from Harare, their families and healthcare workers to develop a film based on their real-life experiences with film makers Tom Gibbs and Joe Njagu. Filmed on location in Zimbabwe, "Chiedza's Song" is based on a true story and was made in collaboration with "Together as One"- a Harare-based youth group that aims to create awareness about HIV and adolescent health issues among communities through drama
The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis
No full textBACKGROUND: People living with HIV (PLWH) are at increased risk of infections with resistant organisms due to more frequent healthcare utilisation.OBJECTIVES: investigate the association between HIV and antimicrobial resistance (AMR).DATA SOURCES: we searched MEDLINE, EMBASE, Web of Science, LILACS and African Journals Online.STUDY ELIGIBILITY CRITERIA: Studies reporting on AMR for colonisation or infection with bacterial pathogens excluding mycobacteria and bacteria causing sexual transmitted infections stratified by HIV status, species and antimicrobials tested.PARTICIPANTS: any.INTERVENTIONS: none.METHODS: Pooled odds ratios were used to evaluate the association between HIV and resistance.RESULTS: A total of 92 studies published between 1995 and 2020 were identified. The studies included the following organisms: Staphylococcus (n=47), Streptococcus pneumoniae (n=28), Escherichia coli (n=6) and other Gram-negative bacteria. PLWH had a 2.12 (95% CI 1.36-3.30) higher odds for colonization and 1.90 (95%CI 1.45-2.48) higher odds for infection with methicillin-resistant S. aureus; a 2.28 (95%CI 1.75-2.97) higher odds of infections with S. pneumoniae with decreased penicillin susceptibility and a 1.59 (95%CI 0.83-3.05) higher odds of resistance to third-generation cephalosporins in E. coli and Klebsiella pneumoniae.CONCLUSION: . This review shows an increased risk of AMR in PLWH across a range of bacterial pathogens and multiple drug classes. The lack of laboratory capacity for identifying AMR and limited access to alternative treatment options in countries with the highest burden of HIV highlights the need for more research on AMR in PLWH. Overall, the quality of studies was moderate or low which may impact the findings of this review
The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe (IMVASK Study): a protocol for a prospective cohort study.
No full textINTRODUCTION: The scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe. METHODS AND ANALYSIS: Children with (n=300) and without HIV (n=300), aged 8-16 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1 year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores <-2) will also be determined. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities
Prevalence of HIV-associated osteoporosis and fracture risk in mid-life women: a cross-sectional study in Zimbabwe
No full textAntiretroviral therapy roll-out has dramatically reduced HIV related-mortality; more women are living to reach menopause. Menopausal estrogen loss causes bone loss, as does HIV and some of its treatments. However, data describing HIV’s impact on osteoporosis prevalence and fracture risk are scarce in southern Africa.A cross-sectional study of women aged 40-60 years (49% women living with HIV (WLH)) was conducted in Harare, Zimbabwe. Menopause, fracture and HIV history were collected, and anthropometry and bone mineral density (BMD, by dual-energy x-ray absorptiometry (DXA)) measured, and FRAX® 10-year fracture probabilities quantified. The FRAX® probability of a major osteoporotic fracture (MOF) included HIV as a risk factor for secondary osteoporosis. Linear and Poisson regression determined the relationships between clinical risk factors and both femoral neck (FN) BMD and the 10-year FRAX® probability of MOF respectively.The 393 participants had mean(SD) age of 49.6(SD = 5.8) years and mean(SD) BMI 29.1(6) kg/m2. 95% of WLH were ART established (85% TDF) and 81% had a viral load <50 copies/mL. A BMD T-Score ≤ -2.5 was more common in WLH than those without, at both FN and lumbar spine (LS) (FN 22[11.4%] vs 5[2.5%], LS 40[20.8%] vs 9[4.5%]; respectively). Prior fracture was more prevalent in WLH: any fracture type (27[14%] vs. 14[7%]); MOF (14[7.3%] vs. 5[2.5%]). WLH had a higher 10-year MOF probability [median 1.2%; IQR: 0.9-1.8] compared with those without HIV [1.0%; IQR: 0.9-1.5] (P<.001), although probabilities were low. Older age, low weight, and HIV infection were strongly associated with lower FN BMD. Higher probability of MOF was associated with older age, HIV infection, parental hip fracture and prior fracture, though adjustment attenuated the association with HIV. No woman reported anti-osteoporosis medication use.While osteoporosis and previous fractures were common and untreated in this relatively young population, particularly in WLH, the FRAX® predicted 10-year MOF risk was low. Clinical risk factors considered in fracture risk prediction tools in Zimbabwe may need contextual modification
The influence of HIV on body composition and its relationship with physical function in mid-life women: a cross-sectional study from Zimbabwe.
No full textOBJECTIVE: Menopause-related changes in body composition and physical function are unclear in Southern Africa, particularly in the context of a generalized HIV epidemic with high antiretroviral therapy (ART) coverage. METHOD: A total of 263 Zimbabwean women (53% women living with HIV [WLH]) aged 40-60 years provided data on menopause, ART use, anthropometry, body composition (appendicular lean mass [ALM], muscle area, fat mass), handgrip strength (HGS) and gait speed. Linear regression determined relationships between body composition and physical function, unadjusted and age-menopause-adjusted, stratified by HIV status. Univariate logistic regression investigated associations between body composition and self-reported falls. RESULTS: WLH (96% ART established) were a median (interquartile range) 10.4 (6.4-14.5) years since diagnosis, with lower weight, body mass index, ALM, fat mass and HGS than women living without HIV (WLWOH). With menopause transition, WLH lost weight, ALM, gynoid mass and muscle area (all p-trend <0.05); however, WLWOH did not. Both WLH and WLWOH lost HGS (p-trend <0.05). ALM was positively associated with HGS in all women. In WLH, greater percentage body fat, particularly gynoid fat, was associated with increased odds of falls (1.69 [1.00-2.89], p = 0.049 and 1.72 [1.08-2.75], p = 0.023, respectively). CONCLUSION: Women living with HIV were more likely to experience adverse changes in body composition through menopause; fat mass gains were associated with risk of falls
HIV-associated cardiovascular disease pathogenesis: an emerging understanding through imaging and immunology
No full textCardiac abnormalities were identified early in the epidemic of AIDS, predating the isolation and characterization of the etiologic agent, HIV. Several decades later, the causation and pathogenesis of cardiovascular disease (CVD) linked to HIV infection continue to be the focus of intense speculation. Before the widespread use of antiretroviral therapy, HIV-associated CVD was primarily characterized by HIV-associated cardiomyopathy linked to profound immunodeficiency. With increasing antiretroviral therapy use, viral load suppression, and establishment of immune competency, the effects of HIV on the cardiovascular system are more subtle. Yet, people living with HIV still face an increased incidence of cardiovascular pathology. Advances in cardiac imaging modalities and immunology have deepened our understanding of the pathogenesis of HIV-associated CVD. This review provides an overview of the pathogenesis of HIV-associated CVD integrating data from imaging and immunologic studies with particular relevance to the HIV population originating from high-endemic regions, such as sub-Saharan Africa. The review highlights key evidence gaps in the field and suggests future directions for research to better understand the complex HIV-CVD interactions
The impact of human immunodeficiency virus and menopause on bone mineral density: a longitudinal study of urban-dwelling South African women
No full textAn estimated 25% of South African women live with human immunodeficiency virus (HIV). Antiretroviral therapy roll-out has improved life expectancy, so many more women now reach menopause. We aimed to quantify changes in bone mineral density (BMD) during the menopausal transition in urban-dwelling South African women with and without HIV and determine whether HIV infection modified the effect of menopause on BMD changes. A 5-year population-based longitudinal study recruited women aged 40–60 years residing in Soweto and collected demographic and clinical data, including HIV status, anthropometry, and BMD, at baseline and at 5-year follow-up. All women were staged as pre-, peri-, or postmenopausal at both time points. Multivariable linear regression assessed relationships and interactions between HIV infection, menopause, and change in BMD. At baseline, 450 women had mean age 49.5 (SD 5.7) years, 65 (14.4%) had HIV, and 140 (31.1%), 119 (26.4%), and 191 (42.4%) were pre-, peri-, and postmenopausal, respectively; 34/205 (13.6%) women ≥50 years had a total hip (TH) or lumbar spine (LS) T-score ≤ −2.5. At follow-up 38 (8.4%), 84 (18.7%), and 328 (72.9%) were pre-, peri-, and postmenopausal. Those with HIV at baseline lost more total body (TB) BMD (mean difference −0.013 [95% confidence interval −0.026, −0.001] g/cm
2, p = 0.040) and gained more weight 1.96 [0.32, 3.60] kg; p = 0.019 than HIV-uninfected women. After adjusting for age, baseline weight, weight change, and follow-up time, the transition from pre- to postmenopause was associated with greater TB BMD losses in women with HIV (−0.092 [−0.042, −0.142] g/cm
2; p = 0.001) than without HIV (−0.038 [−0.016, −0.060] g/cm
2, p = 0.001; interaction p = 0.034). Similarly, in women who were postmenopausal at both time points, those with HIV lost more TB BMD (−0.070 [−0.031, −0.108], p = 0.001) than women without HIV (−0.036 [−0.015, −0.057], p = 0.001, interaction p = 0.049). Findings were consistent but weaker at the LS and TH. Menopause-related bone loss is greater in women with HIV, suggesting women with HIV may be at greater risk of osteoporotic fractures. HIV services should consider routine bone health assessment in midlife women as part of long-term HIV care delivery.</p
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