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Objective To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing), within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic redictors for completion. Methods/n our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested positive for HIV between January 2008 and February 2009. We identified predictors for completion through multivariate logistic regression. Findings Of the 416 patients who tested positive for HIV, 84.6% initiated CD4 testing within the study timeframe. Of these patients, 54.3% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count < 200/µl, but only 51.3% of the patients in this category completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART (CD4 cells >200/ pl), only 14.9% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 65% did not complete it within 12 weeks of diagnosis. The higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks. Conclusion Patient losses between HIV testing, baseline CD4 cell count and the start of care and ART are high. As a result, many patients receive ART too late. Health information systems that link testing programmes with care and treatment programmes are needed. Objectif Estimer les taux de realisation du test de lymphocytes CD4+ (test de CD4) dans les 12 semaines qui suivent un test positif au virus de l'immunodeficience humaine (VIH) dans une grande clinique VIH/SIDA d'Afrique du Sud, et identifier des variables cliniques et demographiques explicatives de cette realisation. Methodes Dans notre etude, le test de CD4 est considere comme acheve lorsqu'un patient retire les resultats de l'analyse. Afin de determiner le taux de realisation du test de CD4, nous avons examine les dossiers cliniques de l'ensemble des patients ayant eu un test positif au VIH entre janvier 2008 et fevrier 2009. Nous avons identifie fies variables explicatives de la realisation par une regression logistique multivariable. Resultats Sur 416 patients testes positifs au VIH, 84,6% ont commence un test de CD4 au cours de la periode d'etude. Parmi ces patients, 54,3% ont ete immediatement eligibles pour une therapie antiretrovirale (TARV) du fait d'une numeration CD4 [is less than or equal to] 200 cellules/µl, mais seulement 51,3% ales patients dans cette categorie ont acheve un test CD4 dans les 12 semaines qui ont suivi le test VIH. Parmi ceux non immediatement eligibles au TARV (CD4 > 200 cellules/µl), 14,9% seulement ont acheve un test de CD4 dans les 12 semaines. Globalement, parmi les patients VIH+ ayant commence un test de CD4, 65% ne l'ont pas acheve dans les 12 semaines qui ont suivi le diagnostic. Plus la numeration cellulaire CD4 de base a ete elevee, moins les chances d'achever un test de CD4 dans les 12 semaines ont ete importantes. Conclusion Les pertes de patients entre le test VIH, la numeration cellulaire CD4 de base et le debut des soins et du TARV sont elevees. En consequence, beaucoup de patients recoivent le TARV trop tard. Des systemes de renseignements sur la sante mettant en relation les programmes de test avec les programmes de soins et de traitement sont necessaires. Objetivos Calcular las tasas de finalizacion del analisis de linfocitos CD4 (analisis de CD4) en las 12 semanas tras las pruebas positivas para el virus de la inmunodeficiencia humana (VIH) en una importante clinica de tratamiento del VIH/SIDA en Sudafrica, e identificar las variables independientes clinicas y demograficas para su finalizacion. Metodos En nuestro estudio, el analisis de CD4 se dio por finalizado una vez que el paciente estuvo en posesion de los resultados de la prueba. Para determinar la tasa de finalizacion del analisis de CD4 se revisaron las historias clinicas de todos los pacientes que dieron positivo en las pruebas del VIH entre enero de 2008 y febrero de 2009. Las variables independientes de finalizacion se identificaron mediante una regresion logistica multivariable. Resultados De los 416 pacientes que dieron positivo en la prueba del VIH, el 84,6% inicio los analisis de CD4 en el periodo de tiempo del estudio. De estos pacientes, el 54,3% fue apto de forma inmediata para el tratamiento antirretroviral (TAR) porque el recuento de linfocitos CD4 era [is less than or equal to] 200/µl, si bien unicamente el 51,3% de los pacientes de esta categoria finalizo el analisis de CD4 en las 12 semanas siguientes a la prueba del VIH. De los pacientes que no fueron inmediatamente aptos para el TAR (linfocitos CD4 > 200/µl), solo el 14,9% finalizo el analisis de CD4 en 12 semanas. En terminos generales, el 65% de los pacientes VIH+ que iniciaron el analisis de CD4 no lo finalizo en las 12 semanas siguientes al diagnostico. Cuanto mayor fue el recuento inicial de linfocitos CD4, menor fue la probabilidad de finalizar los analisis de CD4 en las 12 semanas. Conclusion La perdida de pacientes entre las pruebas del VIH, el recuento inicial de linfocitos CD4 y el inicio de la asistencia y del TAR es elevada, por lo que muchos pacientes reciben el tratamiento antirretroviral demasiado tarde. Se requieren sistemas de informacion sanitaria que enlacen los programas de analisis con los programas de atencion y tratamiento., Introduction Although access to antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in South Africa has increased dramatically since 2004, the majority of patients [...]

Introduction: Several studies from resource‐limited settings have demonstrated that clinical and immunologic criteria are poor predictors of virologic failure, confirming the need for viral load monitoring or at least an algorithm to target viral load testing. We used data from an electronic patient management system to develop an algorithm to identify patients at risk of viral failure using a combination of accessible and inexpensive markers. Methods: We analyzed data from HIV‐positive adults initiated on antiretroviral therapy (ART) in Johannesburg, South Africa, between April 2004 and February 2010. Viral failure was defined as ≥2 consecutive HIV‐RNA viral loads >400 copies/ml following suppression ≤400 copies/ml. We used Cox‐proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI). Weights for each predictor associated with virologic failure were created as the sum of the natural logarithm of the adjusted HR and dichotomized with the optimal cut‐off at the point with the highest sensitivity and specificity (i.e. ≤4 vs. >4). We assessed the diagnostic accuracy of predictor scores cut‐offs, with and without CD4 criteria (CD4 30% drop in CD4), by calculating the proportion with the outcome and the observed sensitivity, specificity, positive and negative predictive value of the predictor score compared to the gold standard of virologic failure. Results: We matched 919 patients with virologic failure (1:3) to 2756 patients without. Our predictor score included variables at ART initiation (i.e. gender, age, CD4 count Conclusions: Predictor scores or risk categories, with CD4 criteria, could be used to identify patients at risk of virologic failure in resource‐limited settings so that these patients may be targeted for focused interventions to improve HIV treatment outcomes., Introduction In 2012, 9.7 million people in low‐ and middle‐income countries received antiretroviral therapy (ART), representing 61% of all who were eligible under the 2010 WHO HIV treatment guidelines [1]. [...]

In South Africa, prevention of mother to child transmission (PMTCT) has reduced MTCT from 3.6% in 2011 to 1.3% in 2017. However, there are challenges in reaching vulnerable HIV-positive children; those at increased risk of malnutrition or present late with advanced disease. Macro – and micronutrient deficiencies, common in HIV, may accelerate disease progression. This was a prospective cohort study of paediatric patients (aged 1–10 years) initiating ART between 08/2014 and 09/2016 at a public health facility in Johannesburg, South Africa. Trained clinic staff collected anthropometric indices and dietary intake at ART initiation and at one and three months post initiation. A blood sample was collected at ART initiation and at six months post initiation for biochemistry. We describe demographics, anthropometry, dietary intake, dietary diversity at enrolment and changes in anthropometry and biochemistry from ART initiation until six months for paediatric HIV-positive patients initiating antiretroviral therapy (ART). Twenty-seven patients were enrolled. The World Health Organization dietary intake recommendations for children were not met for the majority of nutrients including energy, fats, iron, calcium and Vitamin A at ART initiation. At least 40% of patients were receiving less than four of the main food groups. At initiation, 18.5% of children presented with severe acute malnutrition (MUAC <11cm), 14.3% were underweight (weight-for-age Z score <-2SD), 19.1% stunted (height-for-age Z score <-2SD) and 33.4% were wasted (weight-for-height <-2SD). At six months, there was a general increase in WHZ (<5 years), BMI (≥5 years), C-reactive protein, iron and albumin but a significant increase in Vitamin A. The results highlight the need for dietary counselling and provision of nutritional supplementation at ART initiation for paediatric patients. Adequate nutrition should be established early at initiation, to improve growth, development and health outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: Cancer is one of the foremost causes of morbidity and mortality worldwide. Globally, colorectal cancer (CRC) is the third most diagnosed and fourth most important cause of cancer death. A total of 70% of all CRC‐related deaths occur in low‐ and middle‐income countries. In Sub‐Saharan Africa (SSA), estimating the burden of CRC is difficult. Only 27 of 43 SSA countries have formalized cancer registration systems; data quality is variable and national coverage rare. Methods: This is a multidisciplinary, longitudinal cohort study started in January 2016. Patients >18 years with histologically confirmed primary adenocarcinoma of the colon and rectum, diagnosed within the previous 12 months, are eligible. Participants were assessed and were followed up for 3 years. Baseline information, including demographics, socioeconomic status, family history, medical and surgical non‐cancer‐related history, dietary history, colonoscopic findings, staging at presentation, treatment, and disease recurrence, is collected, as well as blood tests and histology results. Outcomes include disease recurrence (local and metastatic) and survival. Results and Conclusion: This study aims to describe the clinical presentation, management, and outcomes of adults with CRC in a multiethnic, urban South African population. It will be the first prospective study to describe clinical presentation, demographics, risk factors, treatment, and outcomes according to population group, from both private and state health‐care facilities in Johannesburg, South Africa. The results of this study will be relevant not only to South Africa but also to other SSA countries undergoing similar rates of rapid urbanization and epidemiological transition. [ABSTRACT FROM AUTHOR]

Background: To date, there is no consensus on ideal ways to measure antiretroviral treatment (ART) adherence in resource limited settings. This study aimed to identify markers of poor adherence to ART. Methods: Retrospective data of HIV-positive ART-naïve adults initiating standard first-line ART at Themba Lethu Clinic, Helen Joseph Hospital, Johannesburg, South Africa from April 2004 to December 2011 were analysed. Poisson regression models with robust error variance were used to assessed the following potential markers of poor adherence ‘last self-reported adherence, missed clinic visits, mean corpuscular volume (MCV), CD4 count against definition of adherence, suppressed HIV viral load using traditional test metrics’. Results: A total of 11 724 patients were eligible; 1712 (14.6%) had unsuppressed viral load within 6 months after initiating ART. The main marker of poor adherence was a combination of change in CD4 count and MCV; change in CD4 ≥expected and change in MCV <14.5 fL (RR 2.82, 95% CI 2.16–3.67), change in CD4

Background: Challenges to HIV care in resource limited settings (RLS) include malnutrition. Limited evidence supports the benefit of nutritional supplementation when starting antiretroviral therapy (ART) in RLS. Methods: Randomized controlled pilot study. HIV-positive ART-naive adults with self-reported weight loss were randomized to receive ART plus FutureLife porridge® nutritional supplement (NS) (388 kcal/day) or ART alone (Controls) for 6 months. Patients returned for monthly assessments and blood was drawn at enrolment and 6 months on ART. Differences in body composition, biochemical and laboratory parameters were estimated at 6 months on treatment. Results: Of the 36 randomized patients, 26 completed the 6 month follow-up (11 NS vs 15 Controls). At enrolment, groups were similar in terms of age, gender, body mass index (BMI) and bioelectrical impedance. NS patients had a lower median CD4 count (60 cells/mm³ [IQR 12-105 vs 107 cells/mm³ [IQR 63-165]; p = 0.149) and hemoglobin (10.3 g/dL [IQR 9.0-11.3] vs 13.1 g/dL [IQR 11.1-14.7]; p = 0.001). At 6 months, NS patients increased their median CD4 count by 151 cells/mm³ [IQR 120-174) vs 77 cells/mm³ [IQR 33-145] in the Controls. NS patients had higher mean percentage change in body weight (12.7% vs 4.9%; p = 0.047), BMI (7.8% vs 5.5%; p = 0.007), absolute CD4 count (83.0% vs 46.4%, p = 0.002) and hemoglobin (9.5% vs 1.0%; p = 0.026). Patients in the NS arm had a higher mean percentage fat-free mass (16.7% vs -3.5%, p = 0.036), total body water (13.0% vs -1.9%, p = 0.026), intracellular water (16.1% vs -4.1%, p = 0.010) and basal metabolic rate (5.3% vs -0.2%, p = 0.014) compared to Controls. Patients in the NS arm also showed an improvement in physical activity at 6 months post-ART initiation compared to Controls (p = 0.037). Conclusion: Preliminary results are encouraging and suggest that NS taken concurrently with ART can promote weight gain, improve immune response and improve physical activity in HIV-positive patients that present at ART initiation with weight loss. [ABSTRACT FROM AUTHOR]

Background: Treatment outcomes for antiretroviral therapy (ART) patients may vary by gender, but estimates from current evidence may be confounded by disease stage and adherence. We investigated the gender differences in treatment response among HIV-positive patients virally suppressed within 6 months of treatment initiation. Methods: We analyzed data from 7,354 patients initiating ART between April 2004 and April 2010 at Themba Lethu Clinic, a large urban public sector treatment facility in South Africa. We estimated the relations among gender, mortality, and mean CD4 response in HIV-infected adults virally suppressed within 6 months of treatment initiation and used inverse probability of treatment weights to correct estimates for loss to follow-up. Results: Male patients had a 20% greater risk of death at both 24 months and 36 months of follow-up compared to females. Older patients and those with a low hemoglobin level or low body mass index (BMI) were at increased risk of mortality throughout follow-up. Men gained fewer CD4 cells after treatment initiation than did women. The mean differences in CD4 count gains made by women and men between baseline and 12, 24, and 36 months were 28.2 cells/mm3 (95% confidence interval [CI] 22.2-34.3), 60.8 cells/mm3 (95% CI 71.1-50.5 cells/mm3), and 83.0 cells/mm3 (95% CI 97.1-68.8 cells/mm3), respectively. Additionally, patients with a current detectable viral load (>400 copies/mL) and older patients had a lower mean CD4 increase at the same time points. Conclusions: In this initially virally suppressed population, women showed consistently better immune response to treatment than did men. Promoting earlier uptake of HIV treatment among men may improve their immunologic outcomes. [ABSTRACT FROM AUTHOR]

Focuses on the commitment of Tempe's Arizona State University (ASU) to international education. ASU affiliate International Educatiion Development Center's (IEDC) agreeement to open the American Language and Culture Program (ALCP)-Japan in May 1990; English training program; Preparing students for transfer to the United States; Impact of American programs on Japanese English education.

While the diagnostic properties of the TB LAM urine assay (LAM) have been well-described, little is known about its predictive and prognostic properties at ART initiation in a routine clinic setting. We describe the predictive and prognostic properties of LAM in HIV-positive patients initiating ART at an urban hospital in Johannesburg, South Africa. Retrospective study of HIV-positive adults (>18 years) who initiated standard first-line ART between February 2012 and April 2013 and had a LAM test at initiation. In HIV-positive patients with no known TB at ART initiation, we assessed the sensitivity, specificity and positive/negative likelihood ratios of LAM to predict incident TB within 6 months of ART initiation. In addition, in patients with a TB diagnosis and on TB treatment <3 months at ART initiation, we measured the CD4 response at 6 months on ART. Of the 274 patients without TB at ART initiation, 65% were female with median CD4 count of 213 cells/mm³. Among the 14 (5.1%) patients who developed active TB, none were urine LAM +ve at baseline. LAM had poor sensitivity (0.0 % 95 % CI 0.00-23.2) to predict incident TB within 6 months of initiation. We analyzed 22 patients with a confirmed TB diagnosis at initiation separately. Of these, LAM +ve patients (27%) showed lower CD4 gains compared to LAM negative patients (median increase 103 vs 199 cells/mm³; p=0.08). LAM has limited value for accurately predicting incident TB in patients with higher CD4 counts after ART initiation. LAM may help identify TB/HIV co-infected patients at ART initiation who respond more slowly to treatment and require targeted interventions to improve treatment outcomes. Larger studies with longer patient follow-up are needed. [ABSTRACT FROM AUTHOR]

Background: We previously reported Kaposi sarcoma-associated herpesvirus (KSHV) microRNA sequence variants in clinical samples correlated with increased risk of multicentric Castleman's disease (MCD). We then demonstrated that microRNAs with variant sequence have different maturation and mature microRNA expression in vitro . Here, we illustrate the association between microRNA sequence and changes in mature microRNA levels within Kaposi sarcoma (KS) lesions., Methods: KSHV microRNA sequences were determined from 20 KS lesions and 4 control skin biopsies from individuals evaluated for KS. Levels of mature KSHV microRNAs were measured with 21 custom small RNA qRT-PCR assays using RNA RNU6B as endogenous control., Results: The levels of 13 KSHV-encoded microRNAs were elevated in KS lesions compared to control biopsies. MicroRNA 9-5p was strongly down regulated in South African vs. US biopsies. Low levels of K12-9-5p were associated with single nucleotide polymorphisms (SNPs) in miR-K12-9-5p, 4-5p, 5-3p, 7-3p and pri-miR-K12-3. One SNP in pri-miR-K12-3 resulted in down regulation of miR-K12-6-3p, 8-3p, 10-3p, 12-5p and the upregulation of 5-5p, illustrating sequence variants outside pre-microRNAs were also associated with changes in mature microRNA levels., Conclusions: The levels of mature KSHV-encoded microRNAs in KS lesions correlate with sequence variation reflecting changes in secondary and tertiary RNA structure., Competing Interests: CONFLICTS OF INTEREST No author reports any conflicts of interest.

Background: Host genetic factors may a play role in susceptibility to infection. Vitamin-D is an immunomodulator that may play a role in HIV infection. Vitamin-D action is mediated by the vitamin-D receptor. We establish prevalence of ApaI, BsmI, FokI and TaqI polymorphisms (VDRPs) amongst a black southern African HIV+ve population and investigate polymorphic differences between HIV+ve and -ve people., Methods: Seventy-nine sex and age-group matched HIV+ve patients of African origin initiating antiretroviral therapy (ART) and 79 HIV-ve participants, also of African origin, were recruited from a public sector HIV testing and treatment clinic and investigated for the 4 polymorphisms. The genotype frequencies were compared, odds ratios and 95% confidence intervals of the association of HIV status and each genotype were calculated. Both dominant, co-dominant, recessive and allele models were tested., Results: We found no evidence of difference in distribution and association between HIV infection and the genotypes of the BsmI, FokI and TaqI VDR polymorphisms. The genotype distributions were consistent with Hardy-Weinberg equilibrium for these genotypes. The ApaI genotype showed differences in distribution by HIV status in the dominant and co-dominant models. However this finding is cautiously stated as the ApaI genotype violated the Hardy-Weinberg equilibrium and frequency of the minor variant was unexpectedly low in this population., Conclusion: We do not show convincing differences in distribution of the VDR genotypes among HIV+ve and HIV-ve black southern African persons. Future studies need to be replicated in larger study populations as understanding polymorphic differences and similarities may offer insights into the different susceptibility and progression of HIV in southern African populations.

There are approximately 33 million individuals with HIV infection worldwide. The majority of infections are in southern Africa where hepatitis B is also known to be endemic. As access to life-saving antiretroviral therapy (ART) increases, the possibility for hepatitis B treatment resistance increases because most ART regimens contain lamivudine. Patients coinfected with HBV are therefore receiving monotherapy for HBV infection, leading to possible HBV-resistant mutants and the concurrent public health effect thereof. Additional information is needed on the prevalence of HIV-HBV coinfection and treatment response to ART. We present a summary of the information available from South Africa to date.