Incidence of HIV-1 infection in a rural region of Uganda

Wawer, Maria J.; Sewankambo, Nelson; Berkley, Seth; Serwadda, David; Musgrave, Stanley D.; Gray, Ron; Musagara, M.; Stallings, Rebecca; Konde-Lule, Joseph

doi:10.1136/bmj.308.6922.171

Cited by 82 publications

(37 citation statements)

References 4 publications

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“…Although the African subjects were evaluated within the first year of HIV-1 infection, the present study did not directly examine acute infection (10). Studies examining microbial translocation in the United States and Europe have consisted of predominantly male populations who most likely contracted the disease through homosexual sex or intravenous drug use, whereas the HIV-infected African population studied here is exclusively heterosexual (11,26,27). Therefore, mode of transmission may play a role in the differences observed between these populations.…”

Section: Discussionmentioning

confidence: 99%

Microbial translocation, the innate cytokine response, and HIV-1 disease progression in Africa

Redd

Dabitao²,

Bream³

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

111

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Reports from the United States have demonstrated that elevated markers of microbial translocation from the gut may be found in chronic and advanced HIV-1 infection and are associated with an increase in immune activation. However, this phenomenon's role in HIV-1 disease in Africa is unknown. This study examined the longitudinal relationship between microbial translocation and circulating inflammatory cytokine responses in a cohort of people with varying rates of HIV-1 disease progression in Rakai, Uganda. Multiple markers for microbial translocation (lipopolysaccharide, endotoxin antibody, and sCD14) did not change significantly during HIV-1 disease progression. Moreover, circulating immunoreactive cytokine levels either decreased or remained virtually unchanged throughout disease progression. These data suggest that microbial translocation and its subsequent inflammatory immune response do not have a causal relationship with HIV-1 disease progression in Africa.

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Section: Discussionmentioning

confidence: 99%

Microbial translocation, the innate cytokine response, and HIV-1 disease progression in Africa

Redd

Dabitao²,

Bream³

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

111

View full text Add to dashboard Cite

show abstract

“…The South African epidemic has developed in the absence of unsafe injections with much data indicating sexual transmission is the cause 23 and Rakai, Uganda, 24 noted no association between injections and risk of HIV-1 infection, whereas those of a third, 25 from Rwanda, indicated no association after adjustment for other variables. The findings of the fourth study, 26 from Masaka, Uganda, in which study participants were interviewed, on average, a year after seroconversion, showed a significant association in men but not women.…”

Section: Transmission Efficiency Via Unsafe Injectionsmentioning

confidence: 99%

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

et al. 2004

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“…Of the 20 PAFs calculated from these 15 studies (with PAFs for two samples in ® ve studies), only four are below 22%, and the unweighted average is 29%. In the four studies of HIV incidence, the unweighted average of ® ve PAFs is 28% 19,80,86,87 . Six of the studies report a positive (but not always signi® cant) dose-response for seropositivity associated with injection frequency 16,77,83± 85,87 .…”

Section: Studies Associating African Hiv Infections With Injectionsmentioning

confidence: 99%

HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

et al. 2002

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An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.

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Incidence of HIV-1 infection in a rural region of Uganda

Cited by 82 publications

References 4 publications

Microbial translocation, the innate cytokine response, and HIV-1 disease progression in Africa

Microbial translocation, the innate cytokine response, and HIV-1 disease progression in Africa

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

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