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SummaryOBJECTIVE To elucidate the relationship between HIV, CD4 ϩ count and pleural TB. METHOD In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10-month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti-TB therapy were followed-up. RESULTS Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18-65; 64 males); the seroprevalence of HIV was 85%. HIV-positive patients were older than HIV-negative individuals (median age 33 vs 23 years, P ϭ 0.013) and had a significantly lower median CD4 ϩ count (191 vs 1106 ϫ 10 6 /l respectively, P ϭ 0.004). A CD4 ϩ count of Ͻ200 ϫ 10 6 /l was associated with a length of illness Ͼ30 days (65% vs 37%; P ϭ 0.05), a positive pleural fluid smear (37% vs 0%; P ϭ 0.0006) and a positive pleural biopsy Ziehl-Neelsen stain (35% vs 7%; P ϭ 0.021). However, a relationship between CD4 ϩ count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed. CONCLUSION In sub-Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD4 ϩ count.keywords pleural tuberculosis, HIV, granuloma, CD4 lymphocyte, Zimbabwe correspondence R. S.Heyderman,

Disclosure of positive HIV status in Sub-Saharan Africa has been associated with safer sexual practices and better antiretroviral therapy (ART) adherence, but associations with psychosocial function are unclear. We examined patterns and psychosocial correlates of disclosure in a Zimbabwean community. Two hundred HIV positive women at different stages of initiating ART participated in a cross-sectional study examining actual disclosures, disclosure beliefs, perceived stigma, self-esteem, depression, and quality of life. Ninety-seven percent of the women disclosed to at least one person, 78% disclosed to their current husband/partner, with an average disclosure of 4.0 persons per woman. The majority (85–98%) of disclosures occurred in a positive manner and 72–95% of the individuals reacted positively. Factors significantly correlated with HIV disclosure to partners included being married, later age at menses, longer duration of HIV since diagnosis, being on ART, being more symptomatic at baseline, ever having used condoms, and greater number of partners in the last year. In multivariate analysis, being married and age at menses predicted disclosure to partners. Positive disclosure beliefs, but not the total number of disclosures, significantly correlated with lower perceived stigma (rho=0.44 for personalized subscale and rho=0.51 for public subscale, both p<0.0001), higher self-esteem (rho=0.15, p=0.04), and fewer depressive symptoms (rho=−0.14, p=0.05). In conclusion, disclosure of positive HIV status among Zimbabwean women is common and is frequently met with positive reactions. Moreover, positive disclosure beliefs correlate significantly with psychosocial measures, including lower perceived stigma, higher self-esteem, and lower depression.

Cryptococcal meningoencephalitis in African children presents acutely or subacutely, can have a fulminant picture and is consistent with progressive meningoencephalitis.

Background: The World Health Organization (WHO)'s "3 × 5 program" has spurred efforts to place 3 million people on combination antiretroviral therapy (ART) for treatment of AIDS in resource-limited countries. Paradoxically, the cost of CD4 + T-lymphocyte count essential for decision-making to commence HIV positive adults on ART as well as for monitoring responses to ART remains unaffordable in most resource-limited countries. Thus, low-cost methods for enumerating CD4 + T-lymphocyte are urgently needed.

Little is known about the psychosocial impact of antiretroviral therapy (ART) among women in sub-Saharan Africa. Therefore, we conducted a cross-sectional study in Zimbabwe to assess the impact of ART on HIV-positive women’s health-related quality of life, using the Medical Outcomes Study-HIV Quality of Life (QOL) questionnaire. Additionally, we assessed socio-demographics, reproductive and sexual health, HIV-related history, disclosure, social stigma, self-esteem, and depression. Structured interviews were conducted with 200 HIV-positive women and categorized into three groups by treatment: (1) Group 1 (n = 31) did not meet clinical or laboratory criteria to begin treatment; (2) Group 2 (n = 73) was eligible to begin treatment but awaiting initiation of treatment; and (3) Group 3 (n = 96) was on ART for a median of 13 months. The women had similar sociodemographic characteristics but varied significantly in clinical characteristics. Women on ART reported fewer AIDS-related symptoms in the last week and year and had higher current and lower baseline CD4 counts compared to women not on ART. On most QOL domains women on ART reported higher mean scores as compared to women not on ART ( p<0.01). Additionally, women on ART reported less depression compared to women not on ART ( p<0.001). Between the two groups of women not on ART, unexpectedly, there were no significant differences in their scores for QOL or depression. Thus, Zimbabwean women living with HIV experience better overall QOL and lower depression on ART. Altogether, our findings suggest that ART delivery in resource-poor communities can enhance overall QOL as well as psychosocial functioning, which has wide-ranging public health implications.

The rapid scale-up of highly active antiretroviral therapy (HAART) and use of single dose Nevirapine (SD NVP) for prevention of mother-to-child transmission (pMTCT) have raised fears about the emergence of resistance to the first line antiretroviral drug regimens. A cross-sectional study was conducted to determine the prevalence of primary drug resistance (PDR) in a cohort of young (<25 yrs) HAART-naïve HIV pregnant women attending antenatal clinics in Chitungwiza, Zimbabwe. Whole blood was collected in EDTA for CD4 counts, viral load, serological estimation of duration of infection using the BED Calypte assay and genotyping for drug resistance. Four hundred and seventy-one women, mean age 21 years; SD: 2.1 were enrolled into the study between 2006 and 2007. Their median CD4 count was 371cells/µL; IQR: 255–511 cells/µL. Two hundred and thirty-six samples were genotyped for drug resistance. Based on the BED assay, 27% were recently infected (RI) whilst 73% had long-term infection (LTI). Median CD4 count was higher (p<0.05) in RI than in women with LTI. Only 2 women had drug resistance mutations; protease I85V and reverse transcriptase Y181C. Prevalence of PDR in Chitungwiza, 4 years after commencement of the national ART program remained below WHO threshold limit (5%). Frequency of recent infection BED testing is consistent with high HIV acquisition during pregnancy. With the scale-up of long-term ART programs, maintenance of proper prescribing practices, continuous monitoring of patients and reinforcement of adherence may prevent the acquisition and transmission of PDR.

High mortality rates due to HIV and AIDS declined in resource rich countries with the discovery and access to anti-retroviral drugs (ARVs), starting with zidovudine in 1985 [5]. Through the Global Fund and concerted efforts of nongovernmental organisations, access to ARVs steadily increased in Sub-Saharan Africa. In addition, the Zimbabwean government initiated the AIDS Levy for all workers in 1999 as a national response to the HIV/AIDS pandemic. The AIDS Levy is a percentage of taxable income (3%) taken from every Zimbabwean employee's salary per month and deposited into the National AIDS Council (NAC) account for use in programs to combat HIV/AIDS in Zimbabwe [6]. By 2008, over 1 million people were infected with HIV and 500 000 required ART, but only a modest 100 000 currently have access to these life-saving drugs [7]. Given the recent evidence that ART not only reduces mortality rates but also reduces transmission rates [8], ART holds the promise to halting the spiral spread of the HIV pandemic. The access to ARVs has not been without difficulties. Earlier use of monotherapy was associated with the emergence of drug resistant variants of HIV [9]. Research in the 1990s led to the discovery of the more effective highly active anti-retroviral therapy (HAART) [10,11]. The use of ARVs was and continues to be associated with moderate, severe and sometimes life threatening adverse drug reactions. For many patients there is a shift from limited access to ARVs to issues of safety and efficacy in their use. As the use of ARVs was accessed by many patients across the world and used for long