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  • 1
    Language: German
    In: Pharmazie in unserer Zeit, January 2010, Vol.39(1), pp.34-40
    Description: Obwohl viele Viruskrankheiten heutzutage in tropischen Ländern häufiger auftreten als hierzulande, sind nur wenige wirklich auf tropische Klimabedingungen angewiesen. Dazu zählen in erster Linie zahlreiche Arboviren, welche von Insekten und Zecken übertragen werden. Der Beitrag stellt die wichtigsten davon kurz vor, beschreibt die klinische Symptomatik und gibt Hinweise zur Diagnostik. Abschließend wird versucht, die aktuellen Veränderungen der Epidemiologie dieser Erreger im Zuge der Klimaerwärmung, aber auch anderer, vorwiegend menschengemachter, Faktoren zu verstehen.
    Keywords: Tropical Medicine ; Virus Diseases -- Therapy;
    ISSN: 0048-3664
    E-ISSN: 1615-1003
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  • 2
    Language: English
    In: Journal of Clinical Microbiology, 2011, Vol. 49(4), p.1704
    Description: We read with interest the study by Gous et al. (2) evaluating the utility of HIV nucleic acid amplification tests (NAAT) of pooled HIV seronegative serum samples to identify acute HIV infections (AHI).
    Keywords: Medicine ; Biology;
    ISSN: 0095-1137
    ISSN: 00951137
    E-ISSN: 1098660X
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  • 3
    Language: English
    In: Vaccine, 26 August 2015, Vol.33(36), pp.4618-4622
    Description: Hepatitis B virus infection (HBV) is a significant public health problem in sub-Saharan Africa. Universal infant vaccination with the hepatitis B (HB) vaccine has been implemented within the South African Expanded Programme of Immunization since April 1995 with concomitant reduction in HBV infection in children. However, the first vaccine dose is only administered at six weeks of age. This delay may lead to a failure to reduce the risk of perinatal HBV transmission to infants born to HIV/HBV co-infected women, in whom HBV infection is often upregulated. The aim of this study was to determine the prevalence of HBV infection in babies born to HIV-infected mothers in the Western Cape, South Africa. HBV serological markers were tested in all infant serum samples and following HB viral load testing, sequencing and genotyping were also performed. Three of 1000 samples screened tested positive for HBsAg and HBV DNA. An additional infant tested positive for HBV DNA alone. All babies had received the HB vaccine at 6, 10 and 14 weeks. The prevalence of HBV infection was therefore 4/1000 (0.4%; 95% CI, 0.01–0.79%). Three of four infants and all four mothers were followed-up. Two infants were persistently positive for HBsAg with viral loads above 10 International Units per millilitre. All four maternal samples were positive for HBsAg and HBeAg and one was also positive for anti-HBe. Sequencing analysis of two mother–child HBV pairs showed 100% sequence identity. This study demonstrates HBV infection in HIV-exposed infants despite HB vaccination from 6 weeks of age. A more strategic approach is needed to prevent mother to child transmission of HBV, including screening of pregnant women, HBV-targeted antiviral therapy and HB birth dose vaccine.
    Keywords: Hbv ; Mother to Child Transmission ; HIV/Hbv Co-Infection ; Vertical Transmission ; Vaccination ; South Africa ; Medicine ; Biology ; Veterinary Medicine ; Pharmacy, Therapeutics, & Pharmacology
    ISSN: 0264-410X
    E-ISSN: 1873-2518
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  • 4
    Language: English
    In: PLoS ONE, 01 January 2017, Vol.12(7), p.e0181267
    Description: Elimination of HIV and syphilis mother-to-child transmission (MTCT) has received much attention but little consideration has been given to the possibility of elimination of HBV MTCT. In sub-Saharan Africa, HBV vertical transmission continues to be reported and it remains an important public health problem. This study aimed to assess the feasibility of screening pregnant women for HBV using a point-of-care (POC) test and implementing interventions to prevent HBV MTCT.In this observational prospective cohort study, HIV-uninfected pregnant women who consented to testing were screened for HBV using a rapid POC test for HBsAg. Positive results were laboratory-confirmed and tested for HBV DNA and serological markers. Women with viral loads ≥ 20 000 IU/ml received tenofovir (TDF) treatment and all infants received birth-dose HBV vaccine. Two blood samples collected six months apart from HBV-exposed infants within their first year of life were tested for HBV DNA.Of 144 women who were approached, 134 consented to participating (93% acceptance rate of HBV POC test). Six women tested positive for HBsAg (4.5%; 95% CI 0.99%-8.01%), all confirmed by laboratory testing. Two mothers, M1 and M4, were treated with TDF during their third trimester of pregnancy. Six HBV-exposed infants received the HBV vaccine within 24 hours of birth, of whom two were lost to follow-up and four (including the two born to M1 and M4) had undetectable levels of HBV DNA when tested at the two time points.We found that HBV screening using POC testing fulfilled the criteria considered necessary for implementation. It has acceptable performance, is inexpensive, reliable, and was well accepted by the study participants. Screening pregnant women as part of the HBV MTCT prevention strategy is therefore feasible in a South African clinical setting.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 5
    In: PLoS ONE, 2013, Vol.8(6)
    Description: Objectives South Africa’s national antiretroviral (ARV) treatment program expanded in 2010 to include the nucleoside reverse transcriptase (RT) inhibitors (NRTI) tenofovir (TDF) for adults and abacavir (ABC) for children. We investigated the associated changes in genotypic drug resistance patterns in patients with first-line ARV treatment failure since the introduction of these drugs, and protease inhibitor (PI) resistance patterns in patients who received ritonavir-boosted lopinavir (LPV/r)-containing therapy. Methods We analysed ARV treatment histories and HIV-1 RT and protease mutations in plasma samples submitted to the Tygerberg Academic Hospital National Health Service Laboratory. Results Between 2006 and 2012, 1,667 plasma samples from 1,416 ARV-treated patients, including 588 children and infants, were submitted for genotypic resistance testing. Compared with 720 recipients of a d4T or AZT-containing first-line regimen, the 153 recipients of a TDF-containing first-line regimen were more likely to have the RT mutations K65R (46% vs 4.0%; p〈0.001), Y115F (10% vs. 0.6%; p〈0.001), L74VI (8.5% vs. 1.8%; p〈0.001), and K70EGQ (7.8% vs. 0.4%) and recipients of an ABC-containing first-line regimen were more likely to have K65R (17% vs 4.0%; p〈0.001), Y115F (30% vs 0.6%; p〈0.001), and L74VI (56% vs 1.8%; p〈0.001). Among the 490 LPV/r recipients, 55 (11%) had ≥1 LPV-resistance mutations including 45 (9.6%) with intermediate or high-level LPV resistance. Low (20 patients) and intermediate (3 patients) darunavir (DRV) cross resistance was present in 23 (4.6%) patients. Conclusions Among patients experiencing virological failure on a first-line regimen containing two NRTI plus one NNRTI, the use of TDF in adults and ABC in children was associated with an increase in four major non- thymidine analogue mutations. In a minority of patients, LPV/r-use was associated with intermediate or high-level LPV resistance with predominantly low-level DRV cross-resistance.
    Keywords: Research Article ; Biology ; Medicine
    E-ISSN: 1932-6203
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  • 6
    In: AIDS, 2017, Vol.31(17), pp.2387-2391
    Description: BACKGROUND:: The WHO-recommended first-line antiretroviral therapy (ART) as a fixed dose combination (FDC) of efavirenz (EFV) and tenofovir disoproxil fumarate (TDF) with lamivudine (3TC) or emtricitabine (FTC) has been preferred in the large scale unprecedented ART roll out in Southern Africa. Models and recent reports suggest that pre-ART HIV drug resistance (PDR) is increasing with high treatment coverage. METHOD:: We therefore investigated PDR and any local transmission clusters in a setting where high treatment coverage was further enhanced by universal test and treat (UTT). Surveillance drug resistance mutations (SDRMs) were identified with an in-house PCR and population sequencing method and calibrated population resistance (CPR) tool. RESULTS:: Of 60 patients, six (10%) had an SDRM mutation: five (8.3%) had nonnucleoside reverse transcriptase (NNRT) mutations, one had an nucleos(t)ide reverse transcriptase inhibitor mutation and none had protease inhibitor (PI) mutations. Phylogenetic analysis revealed no large transmission clusters. CONCLUSION:: An increase to the current moderate PDR levels and the better tolerability and durability, may support a recent drive to avail FDC integrase strand transfer inhibitor (ISTI)-based regimens as the new preferred first-line ART in the Southern African region for individual benefit and to contribute to limiting transmission of infection and drug resistant virus.
    Keywords: Drug Resistance, Viral ; Epidemics ; Anti-Retroviral Agents -- Pharmacology ; Antiretroviral Therapy, Highly Active -- Methods ; HIV Infections -- Epidemiology;
    ISSN: 0269-9370
    E-ISSN: 14735571
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  • 7
    In: Journal of Antimicrobial Chemotherapy, 2002, Vol.49(5), pp.713-721
    Description: In recent years, new therapeutic options have led to enormous improvements in the management of certain chronic viral infections. Nevertheless, it has also become clear that such treatments require careful consideration and follow up. At the same time, a number of new technologies have been developed to measure quantitatively the concentration of viral genome in the patients body fluids. Initially, these tests yielded important insights into the pathogenesis of viral infections and, in the case of human immunodeficiency virus (HIV), in fact revolutionized our understanding of its natural history. In addition, however, such viral load tests have become vital tools in patient management; formerly pure research tools, they are now widely used in routine virological diagnosis, and a number of commercial assays have become available. In clinical virology, viral load testing serves four purposes: for diagnosis; to assess the patients prognosis; as therapeutic markers to monitor the effect of antiviral treatment; and to estimate the patients infectivity, i.e. the risk of transmission. In this review paper, we summarize the current role of viral genome quantification in the clinical management of patients infected with HIV, hepatitis B virus, hepatitis C virus and those at risk of developing human cytomegalovirus-related diseases.
    Keywords: Medicine ; Pharmacy, Therapeutics, & Pharmacology;
    ISSN: 0305-7453
    E-ISSN: 14602091
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  • 8
    Language: English
    In: Journal of Clinical Virology, 2012, Vol.53(2), pp.106-109
    Description: As antibody testing cannot confirm HIV-1 infection in children less than 18 months of age, diagnosis in these children depends on nucleic acid testing. The COBAS AmpliPrep/COBAS TaqMan (CAP/CTM, Roche Molecular Systems, Inc., Branchburg, NJ) HIV-1 Qualitative test is a total nucleic acid real-time PCR assay utilising whole EDTA blood or dried blood spots (DBS), which recently replaced the Roche AMPLICOR DNA test v1.5 (Amplicor) as the diagnostic HIV PCR assay in many South African laboratories. For the Amplicor assay, stringent diagnostic criteria were previously formulated for the local population, and a comparison reported the CAP/CTM's sensitivity at 99.7% and specificity at 100% for both sample types compared to these Amplicor criteria. To validate the assay prior to introduction in our laboratory and to define stringent diagnostic cut-off criteria. Whole EDTA blood samples from patients younger than 18 months sent for routine HIV-1 diagnosis were tested by Amplicor, and positive results were confirmed from DBS. CAP/CTM assays were subsequently performed from DBS. The CAP/CTM had a sensitivity of 98.8% and a specificity of 97.1%, but a positive predictive value (PPV) of only 78.7% compared to the Amplicor assay. Samples positive by CAP/CTM but negative by Amplicor displayed poor amplification curves compared to concordant positive samples. Upon re-testing those with sufficient material available by CAP/CTM, all showed negative results. The decreased PPV may either be due to false positive CAP/CTM results, or increased sensitivity compared to the Amplicor assay. Criteria were formulated for defining presumed false-positive results.
    Keywords: HIV ; Pcr ; Diagnosis ; Dried Blood Spot ; CAP/Ctm ; Biology
    ISSN: 1386-6532
    E-ISSN: 1873-5967
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  • 9
    Language: English
    In: PLoS ONE, 2011, Vol.6(8), p.e23091
    Description: The World Health Organization (WHO) has recommended guidelines for a HIV drug resistance (HIVDR) survey for resource-limited countries. Eligibility criteria for patients include age below 25 years in order to focus on the prevalence of transmitted HIVDR (tHIVDR) in newly-infected individuals. Most of the participating sites across Africa have so far reported tHIVDR prevalences of below 5%. In this study we investigated whether the rate of HIVDR in patients 〈25 years is representative for HIVDR in the rest of the therapy-naïve population. ; HIVDR was determined in 88 sequentially enrolled ART-naïve patients from Mwanza, Tanzania (mean age 35.4 years). Twenty patients were aged 25 years had a significantly higher HIVDR frequency than younger patients (19.1%; 95% CI 0.095–0.28) versus 0%, P = 0.0344). In 2 out of the 16 patients with HIVDR we found traces of antiretrovirals (ARVs) in plasma. ; ART-naïve patients aged over 25 years exhibited significantly higher HIVDR than younger patients. Detection of traces of ARVs in individuals with HIVDR suggests that besides transmission, undisclosed misuse of ARVs may constitute a significant factor in the generation of the observed high HIVDR rate. The current WHO tHIVDR survey that is solely focused on the transmission of HIVDR and that excludes patients over 25 years of age may therefore result in substantial underestimation of the prevalence of HIVDR in the therapy-naïve population. Similar studies should be performed also in other areas to test whether the so far reported optimistic picture of low HIVDR prevalence in young individuals is really representative for the rest of the ART-naïve HIV-infected population.
    Keywords: Research Article ; Medicine ; Public Health And Epidemiology ; Infectious Diseases
    E-ISSN: 1932-6203
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  • 10
    Language: English
    In: 2012, Vol.7(9), p.e44763
    Description: The first year of life represents a time of marked susceptibility to infections; this is particularly true for regions in sub-Saharan Africa. As innate immunity directs the adaptive immune response, the observed increased risk for infection as well as a suboptimal response to vaccination in early life may be due to less effective innate immune function. In this study, we followed a longitudinal cohort of infants born and raised in South Africa over the first year of life, employing the most comprehensive analysis of innate immune response to stimulation published to date. Our findings reveal rapid changes in innate immune development over the first year of life. This is the first report depicting dramatic differences in innate immune ontogeny between different populations in the world, with important implications for global vaccination strategies.
    Keywords: Research Article ; Medicine ; Immunology
    E-ISSN: 1932-6203
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