A Current Bibliography on African Affairs - Baywood Publishing

VOLUME 42, NUMBER 4—2009-2010 / 395
1317. Day, C. L. et al. DETECTION OF POLYFUNCTIONAL MYCOBACTERIUM
TUBERCULOSIS-SPECIFIC T CELLS AND ASSOCIATION WITH VIRAL LOAD IN
HIV-1-INFECTED PERSONS. The Journal of Infectious Diseases. 2008, 197(7):990-999.
The human immunodeficiency virus type 1 (HIV-1) epidemic is associated with a
significant increase in the incidence of tuberculosis (TB); however, little is known about the
quality of Mycobacterium tuberculosis (MTB)-specific cellular immune responses in
coinfected individuals. Polyfunctional MTB-specific CD4 and CD8 T cell responses are
maintained in the peripheral blood of HIV-1-positive individuals, in the absence of active
disease, and the functional capacity of these responses is affected by HIV-1 disease status.
1318. Delgado, E. et al. HIGH PREVALENCE OF UNIQUE RECOMBINANT
FORMS OF HIV-1 IN GHANA: MOLECULAR EPIDEMIOLOGY FROM AN ANTI-
RETROVIRAL RESISTANCE STUDY. Journal of Acquired Immune Deficiency
Syndromes. 2008, 48(5):599-606.
In Ghana, programs to expand antiretroviral access are being implemented. In this
context, the dynamic genetic evolution of HIV-1 requires continuous surveillance, particularly
when diverse genetic forms co-circulate. No major resistance mutations were identified
in the protease, although insertions of one and three amino acids were detected. The
high frequency of URFs detected probably reflects a significant incidence of coinfections
or superinfections with diverse viral strains, which increases the genetic complexity of the
HIV-1 epidemic in West Africa. Monitoring of HIV-1 drug resistance might provide data
on the implications of intersubtype recombination in response to antiretrovirals.
1319. Denny, L. et al. HUMAN PAPILLOMAVIRUS INFECTION AND CERVICAL
DISEASE IN HUMAN IMMUNODEFICIENCY VIRUS-1-INFECTED WOMEN. Obstetrics
and Gynecology. 2008, 111(6):1380-1387.
We report on the natural history of high-risk human papillomavirus (HPV) infection and
cervical disease in human immunodeficiency virus (HIV)-1-infected women living in Cape
Town, South Africa. There is a high level of high-risk HPV infection in HIV-1 infected
women, but progression to HSIL over 36 months occurred in the minority of cases. We
recommend an initial colposcopy for an abnormal test, and if no high-grade lesion is
identified, triennial screening would be appropriate. Human papillomavirus type 16 was the
commonest, and HPV-18 was the fifth commonest, suggesting that vaccination against
these two types would have a significant effect.
1320. Desmond, C. et al. SCALING-UP EXCLUSIVE BREASTFEEDING SUPPORT
PROGRAMS: THE EXAMPLE OF KWAZULU-NATAL. PLoS ONE. 2008, 3(6):e2454.
Exclusive breastfeeding (EBF) for six months is the mainstay of global child health and
the preferred feeding option for HIV-infected mothers for whom replacement feeding is
inappropriate. Promotion of community-level EBF requires effective personnel and management
to ensure quality counselling and support for women. We present a costing and
cost effectiveness analysis of a successful intervention to promote EBF in high HIV
prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-
Natal. The simplified scenario, with a combination of clinic and home visits, is the most
efficient in terms of cost per increased month of EBF and has the lowest incremental cost
effectiveness ratio.