With increasing survival of HIV-infected children, parents face the challenges of disclosure to the children. The aim of this study was to assess the rate of HIV disclosure to children in Ibadan and the factors influencing it in order to guide design of strategies for successful disclosure. A semi-structured questionnaire was administered to consecutive consenting caregivers of HIV-infected children aged ≥6 years attending the Paediatric Infectious Disease Clinic of the University College Hospital, Ibadan, between November 2008 and October 2009. Caregivers of 96 children (46 boys, 50 girls) infected with HIV were interviewed. The ages of the children ranged from 6 to 14 years with a mean (SD) of 8.8 (2.2) years. Disclosure had been done in only 13 (13.5%) of the children; ages at disclosure ranged from 4.5 to 13 years with a mean of 8.7 (SD = 2.2). Disclosure was associated with age above 10 years. Reasons given by carers for non-disclosure in 83 caregivers included inability of the children to understand in 53 (63.9%), fear of disclosure to other children 34 (41.0%), fear of disclosure to family/friends in 28 (33.7%), fear of psychological disturbance of the children in 26 (31.3%) and fear of blaming the parents in 22 (26.5%). Twenty (20.8%) of the children have asked questions relating to their diagnosis and the responses are often evasive. Caregivers felt disclosure had helped adherence to antiretroviral therapy in 7 (63.6%) of the 11 children on antiretroviral drugs in whom there was disclosure but no effect on the remaining. There is a need to assist parents and health care providers in successfully disclosing HIV status to infected children without adverse consequences.

The recently discovered high-frequency transfer of plasmids between strains of Bacillus thuringiensis was used to study the genetic relationship between plasmids and production of the insecticidal 8-endotoxin crystal. Three strains of B. thuringiensis transmitted the Cry' (crystal-producing) phenotype to Cry-(acrystalliferous) B. thuringiensi recipients. Agarose gel electrophoresis showed that one specific plasmid from each donor strain was always present in Cry' "transcipients." The size of the transmissible crystal-coding plasmid varied with the donor strain, being 75 MDal (megadaltons) in size in HD-2, 50 MDal in HD-73, and 44 MDal in HD-263. Immunological analysis showed the Cry' transcipients to be hybrid strains, having flagella of the recipient serotype and crystals of the donor serotype. These results demonstrate that the structural genes for the 6-endotoxin are plasmid borne. Crystal-coding plasmids also transferred into two strains ofthe related species Bacillus cereus and yielded transcipients that produced crystals of the same antigenicity as the donor strain.The Gram-positive sporulating bacterium Bacillus thuringiensis is ofspecial scientific and economic interest because it produces an insecticidal toxin (known as the &.endotoxin) lethal to larvae of a wide range of lepidopterans as well as some dipterans (1). S-Endotoxin appears during sporulation as a crystalline inclusion (the parasporal crystal) that is phase-refractile, proteinaceous, and bipyramidal in most strains (2). Natural isolates of B. thuringiensis have been classified into at least 19 varieties on the basis oftheir flagellar and crystal antigens and their spectra of insecticidal activity (1, 3, 4). The closely related species B. cereus is distinguished by inability to produce the 8-endotoxin (1).Several inconclusive studies have attempted to determine whether the toxin genes are located on extrachromosomal plasmids, which are apparently ubiquitous in strains of B. thuringiensis (5, 6). We have recently implicated specific plasmids in the production of 8-endotoxin by several strains of B. thuringiensis, through analysis ofmutants cured ofindividual plasmids (7). These curing studies could not show whether the plasmids carried the actual toxin gene(s) or, possibly, regulatory genes controlling the expression ofchromosomal toxin genes. A means of genetic transfer was needed to show how a crystal-coding plasmid affected the phenotype of an acrystalliferous (Cry-) strain.We recently discovered that certain B. thuringiensis plasmids could be transmitted between two strains during growth in mixed culture, at frequencies of up to 75% of recipient colonies examined (8). Preliminary results showed that one plasmid previously implicated in toxin production could transfer into a Cry-strain ofa different flagellar serotype, yielding crystalliferous (Cry') transcipients (by "transcipients" we mean recipient cells that have acquired one or more plasmids from a donor strain*). These transcipients, though Cry', still exhibited the basic pla...

BackgroundThe prevalence of Paediatric HIV infection is largely unknown in many countries in sub-Saharan Africa. This study was aimed at determining the prevalence, clinical pattern of HIV infection and outcome among new patients aged <15 years using age-specific diagnostic methods.MethodsA prospective cross sectional study was carried out using the provider initiated HIV testing and counselling (PITC) model. HIV rapid test in parallel was used for screening and confirmation was with HIV DNA PCR in children <18 months and Western Blot in children ≥ 18 months.ResultsA total of 600 children were enrolled with ages ranging between one day and 179 months. Male: female ratio was 1.2:1. HIV seroprevalence was 12.3% and after confirmatory tests, the prevalence was 10%. Fourteen (37.8%) of the children aged less 18 months were exposed but not infected. Mother-to-child transmission accounted for 93.3% of cases. Features predictive of HIV infection were diarrhoea, cough, weight loss, ear discharge generalized lymphadenopathy, presence of skin lesions, parotid swelling and oral thrush. About 75% presented in advanced or severe clinical stages of the disease, 56.8% had severe immunodeficiency while 50% had viral loads more than 100,000 copies/ml. Mortality rate was 14.3% among HIV positive compared with 11.3% in HIV negative children but was not significant. Among the HIV positive children, 26.7% were orphans.ConclusionsThe prevalence rate of HIV infection among new patients screened using the PITC model was high, majority resulting from mother-to-child transmission. Most children presented in advanced stages of the disease and mortality rate among them was high. Though, the study site being a referral centre might have contributed to the high prevalence observed in this study, there is a need to expand access to PMTCT services, ensure implementation of PITC in paediatric settings and expand support services for HIV infected children.