Journal articles: 'HIV infections – Diagnosis – Malawi'

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Chen, Jane S., Mitch Matoga, Shiraz Khan, Edward Jere, Cecilia Massa, Beatrice Ndalama, Arlene C. Seña, et al. "Estimating syphilis seroprevalence among patients in a sexually transmitted infections clinic in Lilongwe, Malawi." International Journal of STD & AIDS 31, no. 4 (February 19, 2020): 359–63. http://dx.doi.org/10.1177/0956462420906762.

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The syndromic management of genital ulcer disease (GUD) misses asymptomatic syphilis cases but is widely utilized in resource-limited settings without diagnostic capabilities to ensure treatment for the most common etiologies of GUD. We used rapid serology tests for syphilis screening at a Malawian sexually transmitted infections clinic. The estimated seroprevalence was 9% and was highest among patients with genital ulcers (26%) and newly diagnosed HIV infection (19%). Rapid syphilis screening has the potential to increase syphilis detection, but accurate patient histories regarding syphilis diagnosis and prior treatment are needed.

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Slaymaker, Emma, Estelle McLean, Alison Wringe, Clara Calvert, Milly Marston, Georges Reniers, Chodziwadziwa Whiteson Kabudula, et al. "The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA): Data on mortality, by HIV status and stage on the HIV care continuum, among the general population in seven longitudinal studies between 1989 and 2014." Gates Open Research 1 (November 6, 2017): 4. http://dx.doi.org/10.12688/gatesopenres.12753.1.

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Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection. Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa. Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services. Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care. For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. Eight studies have the necessary data to estimate mortality by HIV status, and seven can estimate mortality at different stages of the HIV care continuum. This data note describes a harmonised dataset containing anonymised individual-level information on survival by HIV status for adults aged 15 and above. Among PLHIV, the dataset provides information on survival during different periods: prior to diagnosis of infection; following diagnosis but before linkage to care; in pre-antiretroviral treatment (ART) care; in the first six months after ART initiation; among people continuously on ART for 6+ months; and among people who have ever interrupted ART.

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Ellis, Jayne, Newton Kalata, Eltas Dziwani, Agnes Matope, Duolao Wang, Síle F. Molloy, Thomas S. Harrison, David G. Lalloo, Derek Sloan, and Robert S. Heyderman. "Co-prevalent infections in adults with HIV-associated cryptococcal meningitis are associated with an increased risk of death: a nested analysis of the Advancing Cryptococcal meningitis Treatment for Africa (ACTA) cohort." Wellcome Open Research 6 (February 1, 2021): 19. http://dx.doi.org/10.12688/wellcomeopenres.16426.1.

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Background: HIV-associated cryptococcal meningitis accounts for 15% of AIDS related deaths globally. In sub-Saharan Africa, acute mortality ranges from 24% to 100%. In addition to the mortality directly associated with cryptococcosis, patients with HIV-associated cryptococcal meningitis are at risk of a range of opportunistic infections (OIs) and hospital acquired nosocomial infections (HAIs). The attributable mortality associated with co-prevalent infections in cryptococcal meningitis has not been evaluated. Methods: As part of the Advancing Cryptococcal meningitis Treatment for Africa (ACTA) trial, consecutive HIV-positive adults with cryptococcal meningitis were randomised to one of five anti-fungal regimens and followed up until 10-weeks. We conducted a retrospective case note review of ACTA participants recruited from Queen Elizabeth Central Hospital in Blantyre, Malawi to describe the range and prevalence of OIs and HAIs diagnosed, and the attributable mortality associated with these infections. Results: We describe the prevalence of OIs and HAIs in 226 participants. Baseline median CD4 count was 29 cell/mm3, 57% (129/226) were on anti-retroviral therapy. 56% (127/226) had at least one co-prevalent infection during the 10-week study period. Data were collected for 187 co-prevalent infection episodes. Suspected blood stream infection was the commonest co-prevalent infection diagnosed (34/187, 18%), followed by community-acquired pneumonia (32/187, 17%), hospital-acquired pneumonia (13/187, 7%), pulmonary tuberculosis (12/187, 6%) and confirmed blood stream infections (10/187, 5%). All-cause mortality at 10-weeks was 35% (80/226), diagnosis of an OI or HAI increased the risk of death at 10 weeks by nearly 50% (HR 1.48, 95% CI 1.01-2.17, p=0.04). Conclusion: We demonstrate the high prevalence and broad range of OIs and HAIs occurring in patients with HIV-associated cryptococcal meningitis. These co-prevalent infections are associated with a significantly increased risk of death. Whether a protocolised approach to improve surveillance and proactive treatment of co-prevalent infections would improve cryptococcal meningitis outcomes warrants further investigation.

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Loyse, Angela, Godfrey S. Mfinanga, Cecilia Kanyama, Charles Kounfack, Sokoine Lesikari, Chimwemwe Chawinga, Muirgen Stack, and Sile Molloy. "OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY." BMJ Global Health 4, Suppl 3 (April 2019): A10.2—A10. http://dx.doi.org/10.1136/bmjgh-2019-edc.24.

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BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.

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Makombe, Simon D., Anthony D. Harries, Joseph Kwong-Leung Yu, Mindy Hochgesang, Eustice Mhango, Ralf Weigel, Olesi Pasulani, Margaret Fitzgerald, Erik J. Schouten, and Edwin Libamba. "Outcomes of patients with Kaposi's sarcoma who start antiretroviral therapy under routine programme conditions in Malawi." Tropical Doctor 38, no. 1 (January 2008): 5–7. http://dx.doi.org/10.1258/td.2007.060023.

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AIDS-associated Kaposi's sarcoma (KS) is the most common AIDS-related malignancy in sub-Saharan Africa, with a generally unfavourable prognosis. We report on six-month and 12-month cohort treatment outcomes of human immunodeficiency virus (HIV)-positive KS patients and HIV-positive non-KS patients treated with antiretroviral therapy (ART) in public sector facilities in Malawi. Data were collected from standardized antiretroviral (ARV) patient master cards and ARV patient registers. Between July and September 2005, 7905 patients started ART-488 (6%) with a diagnosis of KS and 7417 with a non-KS diagnosis. Between January and March 2005, 4580 patients started ART-326 (7%) with a diagnosis of KS and 4254 with a non-KS diagnosis. At six-months and 12-months, significantly fewer KS patients were alive and significantly more had died or defaulted compared to non-KS patients. HIV-positive KS patients on ART in Malawi have worse outcomes than other patients on ART. Methods designed to improve these outcomes must be found.

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Rucinski, Katherine B., Sarah E. Rutstein, Kimberly A. Powers, Dana K. Pasquale, Ann M. Dennis, Sam Phiri, Mina C. Hosseinipour, et al. "Sustained Sexual Behavior Change After Acute HIV Diagnosis in Malawi." Sexually Transmitted Diseases 45, no. 11 (November 2018): 741–46. http://dx.doi.org/10.1097/olq.0000000000000873.

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Chinguwo, Felix, and Alinane Linda Nyondo-Mipando. "Integration of Early Infant Diagnosis of HIV Services Into Village Health Clinics in Ntcheu, Malawi: An Exploratory Qualitative Study." Journal of the International Association of Providers of AIDS Care (JIAPAC) 20 (January 1, 2021): 232595822098125. http://dx.doi.org/10.1177/2325958220981256.

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Integration of Early Infant Diagnosis(EID) of HIV into Village Health Clinics (VHCs) would increase the uptake of services. This study assessed mothers and health care workers’ acceptability of integration of EID of HIV services into VHCs in Ntcheu, Malawi. We conducted an exploratory qualitative study in the phenomenological tradition among 20 mothers of either HIV exposed or non-exposed infants and 18 health care workers (HCWs) from February to July 2019. We analyzed the data using a thematic approach and guided by the theoretical framework for acceptability. There were positive perceptions of the integration of services. Acceptability is influenced by attitudes, perceived burden, intervention coherent services, and perceived effectiveness of services. The successful integration of EID of HIV into VHCs requires strengthening of the health system and community awareness. Efforts to mitigate stigma should be prioritized when integrating the services to optimize uptake of the services at a community level.

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Low, Andrea, Chloe Teasdale, Kristin Brown, Danielle T. Barradas, Owen Mugurungi, Karam Sachathep, Harriet Nuwagaba-Biribonwoha, et al. "Human Immunodeficiency Virus Infection in Adolescents and Mode of Transmission in Southern Africa: A Multinational Analysis of Population-Based Survey Data." Clinical Infectious Diseases 73, no. 4 (April 29, 2021): 594–604. http://dx.doi.org/10.1093/cid/ciab031.

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Abstract Background Adolescents aged 10–19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015–2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. Methods Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. Results HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%–66.6%) had HIV previously diagnosed, and 47.1% (41.9%–52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. Conclusions These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.

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Cromwell, Elizabeth A., Anna E. Dow, Daniel Low, Chawanangwa Chirambo, Robert S. Heyderman, Queen Dube, and Annelies Van Rie. "Barriers to Successful Early Infant Diagnosis of HIV Infection at Primary Care Level in Malawi." Pediatric Infectious Disease Journal 34, no. 3 (March 2015): 273–75. http://dx.doi.org/10.1097/inf.0000000000000625.

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Gupta-Wright, Ankur, Katherine Fielding, Douglas Wilson, Joep J. van Oosterhout, Daniel Grint, Henry C. Mwandumba, Melanie Alufandika-Moyo, et al. "Tuberculosis in Hospitalized Patients With Human Immunodeficiency Virus: Clinical Characteristics, Mortality, and Implications From the Rapid Urine-based Screening for Tuberculosis to Reduce AIDS Related Mortality in Hospitalized Patients in Africa." Clinical Infectious Diseases 71, no. 10 (November 29, 2019): 2618–26. http://dx.doi.org/10.1093/cid/ciz1133.

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Abstract Background Tuberculosis (TB) is the major killer of people living with human immunodeficiency virus (HIV) globally, with suboptimal diagnostics and management contributing to high case-fatality rates. Methods A prospective cohort of patients with confirmed TB (Xpert MTB/RIF and/or Determine TB-LAM Ag positive) identified through screening HIV-positive inpatients with sputum and urine diagnostics in Malawi and South Africa (Rapid urine-based Screening for Tuberculosis to reduce AIDS Related Mortality in hospitalized Patients in Africa [STAMP] trial). Urine was tested prospectively (intervention) or retrospectively (standard of care arm). We defined baseline clinical phenotypes using hierarchical cluster analysis, and also used Cox regression analysis to identify associations with early mortality (≤56 days). Results Of 322 patients with TB confirmed between October 2015 and September 2018, 78.0% had ≥1 positive urine test. Antiretroviral therapy (ART) coverage was 80.2% among those not newly diagnosed, but with median CD4 count 75 cells/µL and high HIV viral loads. Early mortality was 30.7% (99/322), despite near-universal prompt TB treatment. Older age, male sex, ART before admission, poor nutritional status, lower hemoglobin, and positive urine tests (TB-LAM and/or Xpert MTB/RIF) were associated with increased mortality in multivariate analyses. Cluster analysis (on baseline variables) defined 4 patient subgroups with early mortality ranging from 9.8% to 52.5%. Although unadjusted mortality was 9.3% lower in South Africa than Malawi, in adjusted models mortality was similar in both countries (hazard ratio, 0.9; P = .729). Conclusions Mortality following prompt inpatient diagnosis of HIV-associated TB remained unacceptably high, even in South Africa. Intensified management strategies are urgently needed, for which prognostic indicators could potentially guide both development and subsequent use.

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Ciccacci, Fausto, Francesca Lucaroni, Roberto Latagliata, Laura Morciano, Elisa Mondlane, Moises Balama, Dyna Tembo, et al. "Hematologic alterations and early mortality in a cohort of HIV positive African patients." PLOS ONE 15, no. 11 (November 10, 2020): e0242068. http://dx.doi.org/10.1371/journal.pone.0242068.

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Introduction Infection with Human Immunodeficiency Virus (HIV) is highly prevalent worldwide, especially in Sub-Saharan Africa, where anaemia is also widespread. HIV infection is known to be associated with anaemia and various other haematologic alterations, but little data on correlation with immunological and virologic conditions in treatment-naïve patients and impact on mortality are available. Our study aims to investigate hematologic features in HIV-infected individuals in Malawi and Mozambique and assesses possible correlations with early morality. Material and methods We conducted a retrospective analysis of baseline data (general details, nutritional status, full blood count and HIV infection progress data) and 12 months follow-up status for HIV+ adult patients in 22 health facilities in Malawi (11 sites) and Mozambique (11 sites) run by DREAM program. Anagraphic details, anthropometric characteristics, full blood count, CD4+ count and Viral Load data were collected from electronical medical records (EMR) for all the HIV-positive, treatment-naïve patients starting care in the sites in the period January 2007 –December 2016. Follow-up status after one year since enrolment in care was also considered. All the data extracted from the EMR were included in a dataset and then analysed. Univariate and multivariate analysis were conducted through logistical regression to investigate associations, and survival analysis analysed in a Cox regression model. Results On the whole, 22.657 patients were included; severe and moderate anaemia were observed in 1.174 (8,2%) and 4.703 (21,9%) patients respectively. Gender, nutritional status, CD4+ count, and viral load (VL) were associated with anaemia, leukopenia, and thrombocytopenia. Among 21.166 fully evaluable patients, 8.494 (40,1%) had at least one cytopenia. Any cytopenia was present in 1/3 of patients with normal nutritional status and less advanced HIV infection, and it wouldn’t be diagnosed in a basic HIV care setting. During the first year of treatment, 1.725 subjects (7,6% of the entire sample) died. Anaemia, lower Red blood cells and platelets counts correlated with mortality in the first year of care, independently by body mass index, haemoglobin, CD4+ count and VL. Conclusions Notwithstanding anaemia is known to be associated with HIV infection at diagnosis, full blood count is not routinely performed in many African countries. Our results emphasize that including the study of a broader set of parameters in the routine HIV care services in Sub-Saharan Africa would provide significant clinical information able to predict other alterations and poor outcomes.

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Hauser, Blake M., William C. Miller, Hannock Tweya, Colin Speight, Tiwonge Mtande, Sam Phiri, LM Ball, Mina C. Hosseinipour, Irving F. Hoffman, and Nora E. Rosenberg. "Assessing Option B+ retention and infant follow-up in Lilongwe, Malawi." International Journal of STD & AIDS 29, no. 2 (July 27, 2017): 185–94. http://dx.doi.org/10.1177/0956462417721658.

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Malawi launched Option B+, a program for all pregnant or breastfeeding HIV-positive women to begin lifelong combination antiretroviral therapy (cART), in July 2011. This study characterises a portion of the continuum of care within an antenatal setting in Lilongwe. Women testing HIV-positive and having a cART initiation record at Bwaila Antenatal Clinic from July 2013 to January 2014 were included. Using logistic regression models, we analysed relationships between maternal characteristics and return for infant testing. Among 490 HIV-positive women with a cART initiation record, 360 (73%) were retained at three months. Of these, 203 (56%) were adherent. Records of infant testing were located for 204 women (42%). Women who were not retained were less likely to have an early infant diagnosis record (aOR = 0.20; 95% CI: 0.10, 0.41). Among the women retained, there was a non-significant association between maternal adherence and infant testing (OR = 1.35; 95% CI: 0.89, 2.06). Women lost at earlier continuum stages, who are at higher risk for mother-to-child-transmission, were less likely to bring infants for testing. Even with a test-and-treat program, many women did not remain in care or bring their infant for testing. Facilitating strategies to improve these measures remains an important unmet need.

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Chisale, Master. "A comparative evaluation of three methods for the rapid diagnosis of cryptococcal meningitis (CM) among HIV-infected patients in Northern Malawi." Malawi Medical Journal 32, no. 1 (March 31, 2020): 3–7. http://dx.doi.org/10.4314/mmj.v32i1.2.

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IntroductionCryptococcal meningitis (CM) is the most common systemic fungal infection in patients with HIV infection. Rapid diagnosis and timely initiation of antifungal therapy are key to reducing mortality rate associated with CM. This study aims to evaluate the ability of four different diagnostic tests (Gram stain, India ink, and two types of commercial lateral flow assay [LFA]) to identify CM-positive patients and to compare the sensitivity and specificity of these tests.MethodsThis was a prospective cross-sectional study on diagnostic tests accuracy conducted in Northern Malawi. The target population was HIV-infected adult patients presenting with features of meningitis. Four types of diagnostic tests were conducted: India ink, Gram stain, and two types of commercial lateral flow assay (LFA) (Immy, Inc., OK, USA and Dynamiker Biotechnology (Tianjin) Co., Ltd), Singapore). Culture was conducted as the reference standard.ResultsA total of 265 samples were collected. The rate of positive CM detection ranged from 6.4% (using India ink) to 14.3% (using LFA). India ink exhibited the lowest sensitivity of 54.8% (95% confidence interval [CI]: 36.0%–72.7%), followed by Gram stain (61.3%; 95% CI: 42.2%–78.2%). The Dynamiker LFA exhibited the highest sensitivity of 100.0% (95% CI: 90.0%–100.0%) but a lower specificity (97.0%; 93.9%–98.8%) compared to the Immy LFA (98.3%; 95% CI: 95.7%–99.5%). ConclusionLFA diagnostic methods have the potential to double the detection rate of CM-positive patients in resource-limited countries such as Malawi. As such, LFAs should be considered to become the main diagnostic tests used for CM diagnostics in these countries. Our data indicate that LFAs may be the best method for diagnosing CM and exhibits the highest diagnostic accuracy as it has shown that it outperforms cell culture, the current gold standard.

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Dube, Queen, Anna Dow, Chawanangwa Chirambo, Jill Lebov, Lyson Tenthani, Michael Moore, Robert Heyderman, and Annelies Van Rie. "Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi." Bulletin of the World Health Organization 90, no. 9 (September 1, 2012): 699–704. http://dx.doi.org/10.2471/blt.11.100776.

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Braun, Maureen, Mark M. Kabue, Eric D. McCollum, Saeed Ahmed, Maria Kim, Leela Aertker, Marko Chirwa, et al. "Inadequate Coordination of Maternal and Infant HIV Services Detrimentally Affects Early Infant Diagnosis Outcomes in Lilongwe, Malawi." JAIDS Journal of Acquired Immune Deficiency Syndromes 56, no. 5 (April 2011): e122-e128. http://dx.doi.org/10.1097/qai.0b013e31820a7f2f.

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Pettifor, Audrey, Catherine MacPhail, Amy Corneli, Jabu Sibeko, Gift Kamanga, Nora Rosenberg, William C. Miller, Irving Hoffman, Helen Rees, and Myron S. Cohen. "Continued High Risk Sexual Behavior Following Diagnosis with Acute HIV Infection in South Africa and Malawi: Implications for Prevention." AIDS and Behavior 15, no. 6 (October 27, 2010): 1243–50. http://dx.doi.org/10.1007/s10461-010-9839-0.

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Kelly, Paul M., Robert G. Cumming, John M. Kaldor, and Les M. Irwig. "A New, Clinically-Based Algorithm for the Diagnosis of HIV in African Tuberculosis Patients: Cross-Sectional Analysis from Mzuzu, Malawi." International Journal of STD & AIDS 10, no. 4 (April 1999): 231–36. http://dx.doi.org/10.1258/0956462991913998.

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Gorgan, M., Angela Neacsu, Narcisa Bucur, V. Pruna, Catalina Lipan, Aurelia Mihaela Sandu, and Catioara Fanica Cristescu. "Brain abscesses: management and outcome analysis in a series of 84 patients during 12 year period." Romanian Neurosurgery 19, no. 3 (November 9, 2012): 175–82. http://dx.doi.org/10.2478/v10282-012-0008-z.

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Abstract Authors analyze 84 cases of brain abscesses operated between January 2000 and December 2011, in the Fourth Neurosurgical Department by the same surgical team. We underline the general series profile: the mean age was 42.96 years (range: 11-75 years old), 72.62% were males, association with heart defects in seven cases (8.33%), positive bacteriological examination for germs in only 37 cases (44.04%), all negative for HIV infection. The median number of days to diagnosis was 9. Most frequent clinical presentations included headache (40.47%), fever (35.71%), focal neurologic deficits (29.76%), increased intracranial pressure (28.57%) and seizures (11.90%). The majority of cases (76.19%, n=64) presented a supposed medical condition favoring dissemination of a previous infection: malnutrition, tuberculosis, chronic alcoholism, chronic liver malady, neglected dental or ear infections, and only 5 cases (5.95%) had been diagnosed with secondary immunodeficiency syndromes following autoimmune systemic diseases. According to our treatment policy all cases except for two (treated by puncture and aspiration) benefited of open surgery and total removal of the lesions, without local recurrence. Outcome was favorable in 82.14% (n=69) of subjects. General morbidity was 26.19%, and mortality stood at 7.14%. Six cases remained with permanent motor deficit (7.14%) and four (4.76%) with controllable seizures. Out of a total of 33.33% (n=28) of complications, 64.28% were due to medical causes. Follow-up had been extended up to three years for at least 2/3 of patients, who resolved in time medical or surgical conditions which determined cerebral dissemination of the infection. Despite of a poor medical and biological condition, the patients with brain abscess outside of HIV infections benefit from neurosurgical adequate treatment, and if supportive medical and general therapy is continued and sustained, the healing and survival in good neurological status is the rule. Hematogenous spread and advance age were predictors of poor prognosis. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of aerobe germs

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McCollum, Eric D., Derek C. Johnson, Charles S. Chasela, Linias D. Siwande, Peter N. Kazembe, Dan Olson, Irving Hoffman, Charles van der Horst, and Mina C. Hosseinipour. "Superior Uptake and Outcomes of Early Infant Diagnosis of HIV Services at an Immunization Clinic Versus an “Under-Five” General Pediatric Clinic in Malawi." JAIDS Journal of Acquired Immune Deficiency Syndromes 60, no. 4 (August 2012): e107-e110. http://dx.doi.org/10.1097/qai.0b013e31825aa721.

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Kanyerere, Thokozani, and Asbjørn Aase. "Delays in TB hospital diagnosis – a major threat for the HIV/AIDS situation in a society: A study of TB as an opportunistic infection in southern Malawi." Norsk Geografisk Tidsskrift - Norwegian Journal of Geography 59, no. 1 (March 2005): 55–64. http://dx.doi.org/10.1080/00291950510020529.

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Mezaache, Salim, Hélène Derumeaux, Pierre Ferraro, Pascal Capdebon, Jean-Christophe Steinbach, Xavier Aballe, Deborah Palas, et al. "Validation of an Algorithm Identifying Incident Primary Immune Thrombocytopenia in the French National Health Insurance Database." Blood 128, no. 22 (December 2, 2016): 4764. http://dx.doi.org/10.1182/blood.v128.22.4764.4764.

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Abstract Introduction: Population-based studies using health insurance databases are very useful for epidemiological studies, notably for rare diseases such as immune thrombocytopenia (ITP). French health insurance databases, called SNIIRAM (Système d'Information Inter-Régimes de l'Assurance Maladie) cover the entire French population (66 million inhabitants).We developed an algorithm that identifies incident primary ITP cases in the SNIIRAM. The aim of this study was to evaluate the positive predictive value (PPV) of this algorithm. Methods: The SNIIRAM is an electronic database prospectively recording demographic, hospitalization, long term disabling disease (LTD) and out-hospital drugs dispensing as well as other healthcare data. The algorithm used to identify newly diagnosed primary ITP patients follows several steps: 1) extraction of patients with at least one ITP code (D69.3 code of the International Classification of Disease, version 10 -ICD-10) as primary diagnosis during a hospital stay or as LTD; 2) exclusion of patients with ambiguous or contradictory codes, i.e.other D69 ICD-10 codes as LTD or hospital diagnosis between 12 months before and 6 months after the first ITP code, except D69.6 (thrombocytopenia, unspecified) and D69.9 (hemorrhagic condition, unspecified); 3) refining of the presumed date of diagnosis searching ITP drug dispensing in the six-month period before the first ITP code. A six-month wash out period is used to define incident ITP; 4) lastly, secondary ITPs are defined by a LTD or a hospitalization with codes corresponding to hematological malignancies, chronic viral infections and connective tissue diseases between 12 months before and 6 months after the presumed date of diagnosis. For the present validation study, we applied this algorithm to regional SNIIRAM data of the Midi-Pyrénées region (South of France, 3 million inhabitants) to identify incident ITP patients between July 1, 2012 and June 30, 2014. Medical charts were independently reviewed by two investigators. We calculated the PPVs of: 1) the diagnosis of ITP; 2) the fact that ITP was incident or not (compared with the true date of diagnosis and the true date of first ITP symptoms); 3) the identification of secondary ITPs. Results: We identified 200 incident ITP patients in the Midi-Pyrénées regional SNIIRAM during the study period. We could assess by medical chart review 168 cases. At ITP diagnosis, 70.4% of the patients were adults (≥18 years). Median age was 2.8 years in children and 63.0 years in adults. The male:female sex-ratio was 0.83. Overall, 66.6% of the patients had bleeding symptoms. The median platelet count was 10 x 109/L. After medical chart review, 161 cases were true ITP yielding a PPV of 95.8% (95% confidence interval - 95% CI: 92.8-98.8). Among them, 128 were incident according to the date of symptom onset and 134 were incident according to the true diagnosis date yielding PPVs of 79.5% (95% CI: 73.2-85.7) and 83.2% (95% CI: 77.4-89.0), respectively. As expected, the PPV for newly diagnosed ITP was significantly lower in case of low platelet count as first symptom compared tobleeding revealing ITP (respectively, 65.4%, 95% CI: 52.5-78.3 and 92%, 95% CI 86.9-97.0, p=0.08). The median time from the date of first symptoms and the estimated date of ITP onset by the algorithm was 3 days (interquartile range - IQR: 0 to 20). The median time from the true date of diagnosis and the estimated date of ITP diagnosis by the algorithm was 0 days (IQR: 0 to 15). Ten patients were identified as having a secondary ITP using the algorithm: 4 lymphoid neoplasms (2 B-cell lymphoma, 1 Hodgkin lymphoma and 1 chronic lymphoid leukemia), 4 connective tissue diseases (sarcoidosis, rheumatoid arthritis, systemic sclerosis and Sjögren syndrome, 1 case each) and 2 chronic infections (HIV and HCV). There was no misclassification after medical chart review. On the contrary, 7 secondary ITPs identified by medical chart review were not detected by the algorithm: 3 CMV and 1 EBV infections, 1 Waldenström disease, 1 plasmocytoma and 1 myelodysplastic syndrome. Conclusions: This algorithm showed good PPV in identifying incident primary ITP patients and could be extended to other similar databases. The estimated date of ITP onset may be delayed in case of isolated chronic thrombocytopenia because platelet count results are not recorded in the database. The SNIIRAM is not a useful database to detect virus-associated secondary ITP. Disclosures No relevant conflicts of interest to declare.

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Andreula, C. F., G. Marano, and I. Kambas. "Viral Encephalitis." Rivista di Neuroradiologia 10, no. 3 (June 1997): 357–68. http://dx.doi.org/10.1177/197140099701000308.

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Patients with viral infections of the central nervous system are encountered daily, but it is often difficult to establish a correct differential diagnosis. This paper attempts to “reorganize” our knowledge of such infections. Our starting point was virology, defining the different viruses according to the latest classifications, distinguishing RNA viruses from DNA viruses, assessing capsid shape and dividing each family into genera and species of interest. We then determined the pathophysiology: from initial viraemia we considered the mechanisms of CNS penetration and the pathological changes which ensue. The different species of viruses were found to behave in a broadly similar fashion, accounting for the often very similar radiological findings which make differential diagnosis arduous even for the expert. Lastly, we studied the different forms of slow and acute encephalitis aiming to separate crucial information from useful findings which together with clinical presentation will aid diagnosis. Among the acute forms of encephalitis, the main group comprises herpes encephalitis caused by herpes simplex virus types 1 and 2, cytomegalovirus and varicella-zoster virus. HS1 is usually responsible for severe necrotising meningo-encephalitis; type 2 often presents symmetrical malacic areas in the white matter with little involvement of the grey matter. Cytomegalovirus, which is dangerous mainly to the fetus and neonate, is responsible for dystrophic calcifications and neuronal migration disorders, sometimes resulting in lissencephaly; in immunodepressed patients, it causes atrophy and leukencephalopathy without damage to the brain barrier. Varicella-zoster virus is responsible for transverse myelitis, asectic meningitis and meningo-encephalitis, often presenting a characteristic subtentorial location, sometimes complicated by patchy haemorrhagic lesions. The slow forms of encephalitis include subacute sclerosing panencephalitis caused by measles-like paramyxovirus which presents aspecific signs from neuronal degeneration to atrophy. HIV encephalitis causes atrophy and leucoencephalopathy without damage to the blood brain barrier. Progressive multifocal leucoencephalopathy caused by papavirus is characterized by involvement of the subcortical oligodendrocytes resulting in a leucoencephalopathy presenting a typical finger shape often in a subtentorial site.

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SNELLING, THOMAS, CHRIS OSSOWICZ, and MARK BOYD. "CO-INFECTIONS IN AN HIV-INFECTED MAN FROM MALAWI." American Journal of Tropical Medicine and Hygiene 76, no. 1 (January 1, 2007): 180–81. http://dx.doi.org/10.4269/ajtmh.2007.76.180.

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Fearon, Margaret. "The Laboratory Diagnosis of HIV Infections." Canadian Journal of Infectious Diseases and Medical Microbiology 16, no. 1 (2005): 26–30. http://dx.doi.org/10.1155/2005/515063.

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HIV diagnostic testing has come a long way since its inception in the early 1980s. Current enzyme immunoassays are sensitive enough to detect antibody as early as one to two weeks after infection. A variety of other assays are essential to confirm positive antibody screens (Western blot, polymerase chain reaction [PCR]), provide an adjunct to antibody testing (p24 antigen, PCR), or provide additional information for the clinician treating HIV-positive patients (qualitative and quantitative PCR, and genotyping). Most diagnostic laboratories have complex testing algorithms to ensure accuracy of results and optimal use of laboratory resources. The choice of assays is guided by the initial screening results and the clinical information provided by the physician; both are integral to the laboratory's ability to provide an accurate laboratory diagnosis. Laboratories should also provide specific information on specimen collection, storage and transport so that specimen integrity is not compromised, thereby preserving the accuracy of laboratory results. Point of Care tests have become increasingly popular in the United States and some places in Canada over the past several years. These tests provide rapid, on-site HIV results in a format that is relatively easy for clinic staff to perform. However, the performance of these tests requires adherence to good laboratory quality control practices, as well as the backup of a licensed diagnostic laboratory to provide confirmation and resolution of positive or indeterminate results. Laboratory quality assurance programs and the participation in HIV proficiency testing programs are essential to ensure that diagnostic laboratories provide accurate, timely and clinically relevant laboratory results.

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Stelzle, Dominik, Peter Godfrey-Faussett, Chuan Jia, Obreniokibo Amiesimaka, Mary Mahy, Delivette Castor, Ioannis Hodges-Mameletzis, Lastone Chitembo, Rachel Baggaley, and Shona Dalal. "Estimating HIV pre-exposure prophylaxis need and impact in Malawi, Mozambique and Zambia: A geospatial and risk-based analysis." PLOS Medicine 18, no. 1 (January 11, 2021): e1003482. http://dx.doi.org/10.1371/journal.pmed.1003482.

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Background Pre-exposure prophylaxis (PrEP), a WHO-recommended HIV prevention method for people at high risk for acquiring HIV, is being increasingly implemented in many countries. Setting programmatic targets, particularly in generalised epidemics, could incorporate estimates of the size of the population likely to be eligible for PrEP using incidence-based thresholds. We estimated the proportion of men and women who would be eligible for PrEP and the number of HIV infections that could be averted in Malawi, Mozambique, and Zambia using prioritisation based on age, sex, geography, and markers of risk. Methods and findings We analysed the latest nationally representative Demographic and Health Surveys (DHS) of Malawi, Mozambique, and Zambia to determine the proportion of adults who report behavioural markers of risk for HIV infection. We used prevalence ratios (PRs) to quantify the association of these factors with HIV status. Using a multiplier method, we combined these proportions with the number of new HIV infections by district, derived from district-level modelled HIV estimates. Based on these numbers, different scenarios were analysed for the minimum number of person-years on PrEP needed to prevent 1 HIV infection (NNP). An estimated total of 38,000, 108,000, and 46,000 new infections occurred in Malawi, Mozambique, and Zambia in 2016, corresponding with incidence rates of 0.43, 0.63, and 0.57 per 100 person-years. In these countries, 9%–20% of new infections occurred among people with a sexually transmitted infection (STI) in the past 12 months and 40%–42% among people with either an STI or a non-regular sexual partner (NP) in the past 12 months (STINP). The models estimate that around 50% of new infections occurred in districts with incidence rates ≥1.0% in Mozambique and Zambia and ≥0.5% in Malawi. In Malawi, Mozambique, and Zambia, 35.1%, 21.9%, and 12.5% of the population live in these high-incidence districts. In the most parsimonious scenario, if women aged 15–34 years and men 20–34 years with an STI in the past 12 months living in high-incidence districts were to take PrEP, it would take a minimum of 65.8 person-years on PrEP to avert 1 HIV infection per year in Malawi, 35.2 in Mozambique, and 16.4 in Zambia. Our findings suggest that 3,300, 5,200, and 1,700 new infections could be averted per year in the 3 countries, respectively. Limitations of our study are that these values are based on modelled estimates of HIV incidence and self-reported behavioural risk factors from national surveys. Conclusions A large proportion of new HIV infections in these 3 African countries were estimated to occur among people who had either an STI or an NP in the past year, providing a straightforward means to set PrEP targets. Greater prioritisation of PrEP by district, sex, age, and behavioural risk factors resulted in lower NNPs thereby increasing PrEP cost-effectiveness, but also diminished the overall impact on reducing new infections

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Aboud, S., G. Msamanga, J. S. Read, A. Mwatha, Y. Q. Chen, D. Potter, M. Valentine, et al. "Genital tract infections among HIV-infected pregnant women in Malawi, Tanzania and Zambia." International Journal of STD & AIDS 19, no. 12 (December 2008): 824–32. http://dx.doi.org/10.1258/ijsa.2008.008067.

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De Cock, Kevin M., Anne Porter, Justin Kouadio, Matthieu Maran, Emmanuel Gnaore, Georgette Adjorlolo, Marie-France Lafontaine, et al. "Rapid and specific diagnosis of HIV-1 and HIV-2 infections." AIDS 4, no. 9 (September 1990): 875–78. http://dx.doi.org/10.1097/00002030-199009000-00007.

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Kiwanuka, J., S. M. Graham, J. B. S. Coulter, J. S. Gondwe, N. Chilewani, H. Carty, and C. A. Hart. "Diagnosis of pulmonary tuberculosis in children in an HIV-endemic area, Malawi." Annals of Tropical Paediatrics: International Child Health 21, no. 1 (March 1, 2001): 5–14. http://dx.doi.org/10.1080/02724930020028849.

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Kiwanuka, J., S. M. Graham, J. B. S. Coulter, J. S. Gondwe, N. Chilewani, H. Carty, and C. A. Hart. "Diagnosis of pulmonary tuberculosis in children in an HIV-endemic area, Malawi." Annals of Tropical Paediatrics 21, no. 1 (March 2001): 5–14. http://dx.doi.org/10.1080/02724930125056.

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Muula, Adamson S. "What Should HIV/AIDS be Called in Malawi?" Nursing Ethics 12, no. 2 (March 2005): 187–92. http://dx.doi.org/10.1191/0969733005ne781oa.

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HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the Queen Elizabeth Central Hospital, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; rather, they prefer to use ‘SGOT’, ‘ELISA’ and ‘spot test’ to represent the HIV test, while ‘immunosuppression’, ‘↓ CD4 disease’ and ‘ARC’ are preferred instead of ‘AIDS’. It is possible that health professionals’ belief that mentioning HIV and/or AIDS will harm patients is encouraging them to use these euphemisms. The use of less than exact terms to label HIV and AIDS may not be without cost. For instance, future attempts to conduct retrospective case study research may be hampered by this practice, which is not in accordance with the international classification of diseases. It is suggested that, although stigmatization and discrimination could be important driving factors in the use of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated.

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Little, K. M., M. Khundi, G. L. Barnes, L. G. Ngwira, A. Nkhoma, S. Makombe, E. L. Corbett, R. E. Chaisson, and D. W. Dowdy. "Predictors of isoniazid preventive therapy completion among adults newly diagnosed with HIV in rural Malawi." International Journal of Tuberculosis and Lung Disease 22, no. 4 (April 1, 2018): 371–77. http://dx.doi.org/10.5588/ijtld.16.0836.

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Talal, Andrew H., Louis M. Weiss, and Charles Vanderhorst. "MOLECULAR DIAGNOSIS OF GASTROINTESTINAL INFECTIONS ASSOCIATED WITH HIV INFECTION." Gastroenterology Clinics of North America 26, no. 2 (June 1997): 417–44. http://dx.doi.org/10.1016/s0889-8553(05)70302-2.

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Bowen, Lauren N., Bryan Smith, Daniel Reich, Martha Quezado, and Avindra Nath. "HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment." Nature Reviews Neurology 12, no. 11 (October 27, 2016): 662–74. http://dx.doi.org/10.1038/nrneurol.2016.149.

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Costello, C., S. Rule, D. Shanson, and N. Mir. "Bone-marrow diagnosis of opportunistic infections in HIV disease." AIDS 6, no. 12 (December 1992): 1559–60. http://dx.doi.org/10.1097/00002030-199212000-00033.

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Nwanyanwu, Okey, Daniel Nyangulu, and Felix Salaniponi. "Persistent Cough in Patients Using an Urban Chest Clinic in Malawi." Tropical Doctor 26, no. 4 (October 1996): 165–67. http://dx.doi.org/10.1177/004947559602600408.

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In many sub-Saharan African countries, tuberculosis (TB) cases have been increasing steadily since 1985. In Malawi, they have increased by 38% from 1990 to 1993, and extrapulmonary TB increased by 79%. Among 385 patients with a history of persistent cough presumed to be TB, 360 (94%) initially consented to be tested for both HIV and TB. Of these, 301 completed testing and 95% returned for their test results. Among test completers ( n = 301), 280 (93%) were found to be HIV-infected. Seropositivity rates were similar for males and females, and higher for urban dwellers than for rural dwellers (94% versus 79%). TB was found in only 48 (16%) patients. Among TB patients, 33 (77%) were HIV positive. This study suggests that TB may not be the main cause of persistent cough among persons using urban chest clinics in Malawi; HIV without sputum positive TB appears to be a major contributor. Clinicians in areas of high HIV prevalence should therefore suspect other HIV-related infections in a patient with persistent cough and in whom TB has been ruled out.

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Kourtis, Athena P., Jeffrey Wiener, Tiffany S. Chang, Sheila C. Dollard, Minal M. Amin, Sascha Ellington, Dumbani Kayira, Charles van der Horst, and Denise J. Jamieson. "Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi." Clinical and Vaccine Immunology 22, no. 12 (September 30, 2015): 1222–26. http://dx.doi.org/10.1128/cvi.00460-15.

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ABSTRACTCytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infections. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infections. Taken together, these results show that the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG; most of them (70.9%) had IgG of high avidity. The CMV serology and avidity testing, combined with the PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. The CMV PCR in blood detected most, but not all, infant CMV infections.

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Dennis, Ann M., Myron S. Cohen, Katherine B. Rucinski, Sarah E. Rutstein, Kimberly A. Powers, Dana K. Pasquale, Sam Phiri, et al. "Human Immunodeficiency Virus (HIV)-1 Transmission Among Persons With Acute HIV-1 Infection in Malawi: Demographic, Behavioral, and Phylogenetic Relationships." Clinical Infectious Diseases 69, no. 5 (November 26, 2018): 853–60. http://dx.doi.org/10.1093/cid/ciy1006.

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AbstractBackgroundUnderstanding sexual networks involving acute human immunodeficiency virus (HIV)-1 infections (AHI) may lead to prevention opportunities to mitigate high rates of onward transmission. We evaluated HIV-1 phylogenetic and behavioral characteristics among persons with AHI and their referred partners.MethodsBetween 2012 and 2014, 46 persons with AHI in Malawi participated in a combined behavioral and biomedical intervention. Participants referred sexual partners by passive referral. Demographics and sexual behaviors were collected through interviews and HIV-1 genetic relationships were assessed with phylogenetics.ResultsAmong 45 AHI participants with HIV-1 sequences, none was phylogenetically-linked with another AHI index. There were 19 (42%) AHI participants who referred a single partner that returned for testing. Most partners (n = 17) were HIV-infected, with 15 (88%) presenting with an established infection. There were 14 index-partner pairs that had sequences available; 13 (93%) pairs were phylogenetically-linked dyads. The AHI index was female in 7/13 (54%) dyads. Age-disparate relationships among dyads were common (≥5-year age difference in 67% of dyads), including 3/6 dyads involving a male index and a younger woman. Index participants with a referred partner were more likely to report no casual partners and to be living with their current partner than participants not in dyads.ConclusionsPassive-partner referral successfully identified partners with genetically-similar HIV infections—the likely source of infection—but only 40% of index cases referred partners who presented for HIV-1 testing. Future work evaluating assisted partner notification may help reach susceptible partners or more people with untreated HIV-1 infections connected to acute transmission.Clinical Trials RegistrationNCT01450189

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Masamba, Leo Peter Lockie, Yankho Jere, Ewan Russell Stewart Brown, and Dermot Robert Gorman. "Tuberculosis Diagnosis Delaying Treatment of Cancer: Experience From a New Oncology Unit in Blantyre, Malawi." Journal of Global Oncology 2, no. 1 (February 2016): 26–29. http://dx.doi.org/10.1200/jgo.2015.000299.

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Purpose Malawi is a low-income country in sub-Saharan Africa with limited health care infrastructure and high prevalance of HIV and tuberculosis. This study aims to determine the characteristics of patients presenting to Queen Elizabeth Central Hospital Oncology Unit, Blantyre, Malawi, who had been treated for tuberculosis before they were diagnosed with cancer. Methods Clinical data on all patients presenting to the oncology unit at Queen Elizabeth Central Hospital from 2010 to 2014 after a prior diagnosis of tuberculosis were prospectively recorded, and a descriptive analysis was undertaken. Results Thirty-four patients who had been treated for tuberculosis before being diagnosed with cancer were identified between 2010 and 2014, which represents approximately 1% of new referrals to the oncology unit. Forty-one percent of patients were HIV positive. Mean duration of tuberculosis treatment before presentation to the oncology unit was 3.6 months. The most common clinical presentation was a neck mass or generalized lymphadenopathy. Lymphoma was the most common malignancy that was subsequently diagnosed in 23 patients. Conclusion Misdiagnosis of cancer as tuberculosis is a significant clinical problem in Malawi. This study underlines the importance of closely monitoring the response to tuberculosis treatment, being aware of the possibility of a cancer diagnosis, and seeking a biopsy early if cancer is suspected.

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Almeida, Sérgio Monteiro de. "Cerebrospinal fluid analysis in the HIV infection and compartmentalization of HIV in the central nervous system." Arquivos de Neuro-Psiquiatria 73, no. 7 (July 2015): 624–29. http://dx.doi.org/10.1590/0004-282x20150071.

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The nervous system plays an important role in HIV infection. The purpose of this review is to discuss the indications for cerebrospinal fluid (CSF) analysis in HIV infection in clinical practice. CSF analysis in HIV infection is indicated for the diagnosis of opportunistic infections and co-infections, diagnosis of meningitis caused by HIV, quantification of HIV viral load, and analysis of CNS HIV compartmentalization. Although several CSF biomarkers have been investigated, none are clinically applicable. The capacity of HIV to generate genetic diversity, in association with the constitutional characteristics of the CNS, facilitates the generation of HIV quasispecies in the CNS that are distinct from HIV in the systemic circulation. CSF analysis has a well-defined and valuable role in the diagnosis of CNS infections in HIV/AIDS patients. Further research is necessary to establish a clinically applicable biomarker for the diagnosis of HIV-associated neurocognitive disorders.

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Levy, Jennifer M. "Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi." Reproductive Health Matters 17, no. 33 (January 2009): 152–61. http://dx.doi.org/10.1016/s0968-8080(09)33436-9.

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Kumwenda, J. J., G. Mateyu, S. Kampondeni, A. P. van Dam, L. van Lieshout, and E. E. Zijlstra. "Differential Diagnosis of Stroke in a Setting of High HIV Prevalence in Blantyre, Malawi." Stroke 36, no. 5 (May 2005): 960–64. http://dx.doi.org/10.1161/01.str.0000162585.97216.ef.

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Adewumi, Olubusuyi Moses, Elena Dukhovlinova, Nathan Y. Shehu, Shuntai Zhou, Olivia D. Council, Maxwell O. Akanbi, Babafemi Taiwo, et al. "HIV-1 Central Nervous System Compartmentalization and Cytokine Interplay in Non-Subtype B HIV-1 Infections in Nigeria and Malawi." AIDS Research and Human Retroviruses 36, no. 6 (June 1, 2020): 490–500. http://dx.doi.org/10.1089/aid.2019.0245.

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Horner, Marie-Josèphe, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, et al. "Frequent HIV and Young Age Among Individuals With Diverse Cancers at a National Teaching Hospital in Malawi." Journal of Global Oncology, no. 4 (December 2018): 1–11. http://dx.doi.org/10.1200/jgo.17.00174.

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Purpose Cancer surveillance provides a critical evidence base to guide cancer control efforts, yet population-based coverage in Africa is sparse. Hospital-based registries may help fill this need by providing local epidemiologic data to guide policy and forecast local health care needs. We report the epidemiology of patients with cancer recorded by a de novo hospital-based cancer registry at Kamuzu Central Hospital, Malawi, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory. Methods We conducted active case finding across all hospital departments and the pathology laboratory from June 2014 to March 2016. Patient demographics, tumor characteristics, treatment, and HIV status were collected. We describe epidemiology of the cancer caseload, registry design, and costs associated with registry operations. Results Among 1,446 registered patients, Kaposi sarcoma and cervical cancer were the most common cancers among men and women, respectively. Burkitt lymphoma was most common cancer among children. The current rate of pathology confirmation is 65%, a vast improvement in the diagnostic capacity for cancer through the hospital’s pathology laboratory. Among leading cancer types, an alarming proportion occurred at young ages; 50% of Kaposi sarcoma and 25% of esophageal, breast, and cervical cancers were diagnosed among those younger than 40 years of age. A systematic, cross-sectional assessment of HIV status reveals a prevalence of 58% among adults and 18% among children. Conclusion We report a high caseload among typically young patients and a significant burden of HIV infection among patients with cancer. In low- and middle-income countries with intermittent, sparse, or nonexistent cancer surveillance, hospital-based cancer registries can provide important local epidemiologic data while efforts to expand population-based registration continue.

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Tzeng, Jeff S., Leslie L. Clark, Eric C. Garges, and Jean Lin Otto. "Epidemiology of Sexually Transmitted Infections among Human Immunodeficiency Virus Positive United States Military Personnel." Journal of Sexually Transmitted Diseases 2013 (April 21, 2013): 1–8. http://dx.doi.org/10.1155/2013/610258.

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Background. Minimal data exist that describe the epidemiology of sexually transmitted infections (STI) in human immunodeficiency virus (HIV) positive populations across the pre- and post-diagnosis periods for HIV. Purpose. The purpose of this study was to identify and describe the epidemiology of gonorrhea, chlamydia, syphilis, herpes simplex virus, and human papillomavirus in an HIV-positive population. Methods. All 1,961 HIV seropositive United States active duty military personnel from 2000–2010 were identified. STI diagnoses relative to HIV diagnosis from 1995, which was the earliest electronic medical record available, to 2010 were examined. Results. The incidence diagnosis rates of STI generally increased during the period leading up to eventual HIV diagnosis. The rates of STI during the post-HIV diagnosis period fluctuated, but remained elevated compared to pre-HIV diagnosis period. Approximately 45%–69% with an STI in the HIV seropositive military population were diagnosed with their first STI greater than one year after their HIV diagnosis. Of those who were diagnosed with an STI in the post-HIV diagnosis period, 70.6% had one STI diagnosis, 23.5% had two STI diagnoses, and 5.8% had three or more STI diagnoses. Conclusions. Despite aggressive counseling, high-risk sexual behavior continues to occur in the HIV-positive military population.

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Hasan, Zahra, Sharaf Shah, Rumina Hasan, Shoaib Rao, Manzoor Ahmed, Mars Stone, and Michael Busch. "Late diagnosis of human immunodeficiency virus infections in high-risk groups in Karachi, Pakistan." International Journal of STD & AIDS 29, no. 14 (August 13, 2018): 1400–1406. http://dx.doi.org/10.1177/0956462418785264.

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Human immunodeficiency virus (HIV) infection prevalence in Pakistan has been increasing in high-risk groups, including people who inject drugs (PWID) and transgender hijra sex workers (TG-HSWs) nationwide. Effective control of HIV requires early diagnosis of the infection. We investigated recency of HIV infections in newly-diagnosed cases in PWID and TG-HSWs. This was an observational study with convenience sampling. Overall, 210 HIV-positive subjects comprising an equal number of PWID and TG-HSWs were included. Antibody avidity was tested using the Maxim HIV-1 Limiting Antigen Avidity (LAg) EIA (Maxim Biomedical, Inc. Rockville, Maryland, USA). The mean age of study subjects was 29.5 years: PWID, 28.5 years and TG-HSWs, 30.4 years. Study subjects were married, 27%, or unmarried. Eighteen percent of individuals had recently-acquired HIV infections: 19% of PWID and 17% of TG-HSWs. Eighty-two percent of individuals had long-term HIV infections: 81% of PWID and 83% of TG-HSWs. This is the first study identification of recent HIV-1 infections in Pakistan. We show that most newly-diagnosed HIV patients in the high-risk groups studied had long-term infections. There is an urgent need for intervention in these groups to facilitate early diagnosis and treatment of HIV infection to reduce transmission in Pakistan.

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O’Shaughnessy, MV, and S. Cassol. "Laboratory Diagnosis of HIV Infection." Canadian Journal of Infectious Diseases 5, suppl e (1994): 7E—12E. http://dx.doi.org/10.1155/1994/317672.

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The laboratory diagnosis of HIV infection has progressed greatly since the introduction of the commercially prepared, HIV antibody assay in 1985. However, the antibody assay remains the gold standard since the sensitivity and specificity of properly performed tests exceed 99%. Recent progress in diagnostic test development includes the availabilily of reliable HIV p-24 antigen capture assays with improved sensitivity due lo the elimination of immune complexes of antibody and p-24 antigen and enhanced specificity due lo the availabilily of confirmatory (neutralizing) reagents. HIV culture procedures have been optimized and standardized with isolation rates of the virus from HIV antibody positive persons approaching 95%. This technology is labour intensive and requires special containment facilities. The polymerase chain reaction. and other amplification methods. such as the branched chain reaction. are used to search for the presence of HIV genclic informalion. These technologies are exquisitely sensitive but offer little routine advantage to the standard HIV anlibody assay. There are specific circumstances. such as the diagnosis of perinatal infections and measuring the efficacy of potential agents for the treatment of HIV disease. where this technology is appropriate. The unique performance characteristics of these two amplification procedures necessitate thal they be performed only in laboralories wilh adequate physical facilities and ongoing qualily assurance programs. Assays for determining the antiviral sensitivity of HIV to specific drugs and for phenotyping viral isolates have been developed in research centres and are presently being introduced into clinical laboratories across Canada.

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Lukefahr, Ashley, and Barun De. "Laboratory Diagnosis of HIV in the Outpatient Setting: One Hospital’s Perspective." American Journal of Clinical Pathology 152, Supplement_1 (September 11, 2019): S20—S21. http://dx.doi.org/10.1093/ajcp/aqz112.040.

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Abstract Traditional methods for the diagnosis of human immunodeficiency virus types 1 and 2 (HIV-1, HIV-2) involve initial screening by an immunoassay followed by a specific method Western blot. However, Western blot is not sensitive compared to third-generation immunoassay, which detects both IgG and IgM antibodies against viral envelope proteins causing false-positive results. In addition, neither initial screening nor confirmatory Western blot is capable of detecting acute infection earlier in the disease process, when the virus is more adaptable and highly infectious. To detect both acute and established infection, Abbott Architect platform introduced a new fourth-generation antigen/antibody initial screening assay in 2013. Also, to reduce false-negative results from Western blot, an alternate method Bio-Rad multisport immunoassay was recommended by the Centers for Disease Control and Prevention (CDC) that has higher sensitivity and can differentiate HIV-1 and HIV-2 infections. In 2014, the CDC released updated recommendations for the laboratory diagnosis of HIV. The CDC diagnostic algorithm recommends an initial combination immunoassay that detects HIV-1 and HIV-2 antibodies, followed by supplemental testing with an immunoassay that differentiates HIV-1 and HIV-2 antibodies. Specimens reactive on the initial antigen/antibody immunoassay but nonreactive or indeterminate on the differentiation immunoassay should be followed by nucleic acid testing (NAT) for resolution of this discrepancy. The objective of our study was to review the effect of this updated testing algorithm on HIV testing results in the outpatient setting at Banner University Medical Center–Tucson in Tucson, Arizona. Our study utilized laboratory information system queries to retroactively review all outpatient HIV laboratory testing results obtained from 2013 to 2017. A total of 17,397 HIV-1/2 antigen/antibody immunoassays were performed during this time period. Of the initial antigen/antibody immunoassays, 1.1% were reactive (n = 183). Of these reactive tests, 85% were collected from individuals with established HIV infections (n = 155). HIV-1/HIV-2 antibody differentiation assays were performed on 175 patients, with 86% reactive (n = 150), 2.3% indeterminate (n = 4), and 12% nonreactive (n = 21). Acute HIV-1 infections (antigen/antibody immunoassay reactive, antibody differentiation immunoassay nonreactive or indeterminate, and NAT positive) accounted for 2.7% of patients with reactive initial antigen/antibody immunoassays and 0.03% of all patients screened for HIV infection with the initial antigen/antibody immunoassay (n = 5). Viral loads in the patients with acute HIV-1 infection ranged from 173,000 to >10,000,000 copies/mL. No HIV-2 infections were identified in our patient population. Given that the previous CDC testing algorithm for HIV-1 failed to identify acute HIV-1 infections, our data, which confirm the ability of the current CDC algorithm to detect HIV-1 infections, represent important information for infectious disease practitioners, public health officials, and laboratory directors.

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MacPherson, Peter, Emily L. Webb, David G. Lalloo, Marriott Nliwasa, Hendramoorthy Maheswaran, Elizabeth Joekes, Dama Phiri, Bertie Squire, Madhukar Pai, and Elizabeth L. Corbett. "Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study)." Wellcome Open Research 3 (May 18, 2018): 61. http://dx.doi.org/10.12688/wellcomeopenres.14598.1.

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Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under “real-life” conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018)

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MacPherson, Peter, Emily L. Webb, David G. Lalloo, Marriott Nliwasa, Hendramoorthy Maheswaran, Elizabeth Joekes, Dama Phiri, Bertie Squire, Madhukar Pai, and Elizabeth L. Corbett. "Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study)." Wellcome Open Research 3 (July 30, 2018): 61. http://dx.doi.org/10.12688/wellcomeopenres.14598.2.

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Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under “real-life” conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018)

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MacPherson, Peter, Emily L. Webb, David G. Lalloo, Marriott Nliwasa, Hendramoorthy Maheswaran, Elizabeth Joekes, Dama Phiri, Bertie Squire, Madhukar Pai, and Elizabeth L. Corbett. "Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study)." Wellcome Open Research 3 (November 21, 2018): 61. http://dx.doi.org/10.12688/wellcomeopenres.14598.3.

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Background: Adults seeking diagnosis and treatment for tuberculosis (TB) and HIV in low-resource settings face considerable barriers and have high pre-treatment mortality. Efforts to improve access to prompt TB treatment have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can best be implemented. Design and methods: The PROSPECT Study is an open, three-arm pragmatic randomised study that will investigate the effectiveness and cost-effectiveness of optimised HIV and TB diagnosis and linkage to care interventions in reducing time to TB diagnosis and prevalence of undiagnosed TB and HIV in primary care in Blantyre, Malawi. Participants (≥ 18 years) attending a primary care clinic with TB symptoms (cough of any duration) will be randomly allocated to one of three groups: (i) standard of care; (ii) optimised HIV diagnosis and linkage; or (iii) optimised HIV and TB diagnosis and linkage. We will test two hypotheses: firstly, whether prompt linkage to HIV care should be prioritised for adults with TB symptoms; and secondly, whether an optimised TB triage testing algorithm comprised of digital chest x-ray evaluated by computer-aided diagnosis software and sputum GeneXpert MTB/Rif can outperform clinician-directed TB screening. The primary trial outcome will be time to TB treatment initiation by day 56, and secondary outcomes will include prevalence of undiagnosed TB and HIV, mortality, quality of life, and cost-effectiveness. Conclusions: The PROSPECT Study will provide urgently-needed evidence under “real-life” conditions to inform clinicians and policy makers on how best to improve TB/HIV diagnosis and treatment in Africa. Clinical trial registration: NCT03519425 (08/05/2018)

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Journal articles on the topic 'HIV infections – Diagnosis – Malawi'

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