Time to initiation of antiretroviral therapy among patients with HIV-associated tuberculosis in Cape Town, South Africa

We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n = 1433; median CD4 count 71 cells per microliter, interquartile range: 32-132) attending 3 South African township ART services between 2002 and 2008. The overall median delay was 2.66 months (interquartile range: 1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7%, and 51.1% of patients started ART within 2, 4, and 8 weeks of tuberculosis treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines.

Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration

OBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naive children (< or = 16 years) who commenced treatment with > or = 3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being < 18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (< 400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.

First Record of Freshwater Fish on the Cape Verdean Archipelago

The Cape Verdean islands form a distinct aquatic freshwater ecoregion characterized mainly by temporal water bodies with an adapted invertebrate community. Freshwater fish were not previously recorded from the archipelago. During a non-exhaustive survey of freshwater bodies on five islands of the archipelago, the first presence of a freshwater fish was recorded. Using barcoding sequences, the species was identified as the guppy (Poecilia reticulata), a highly invasive species alien to the Cape Verdean Islands.

Eine siyāḥa als Bildungsroman? Überlegungen zur Organisation des Reisetextes von Ḥannā Diyāb (1763/64)

Ḥannā Diyābs siyāḥa umfasst Reiseerfahrungen eines jungen Maroniten aus Aleppo, der den französischen Gesandten Paul Lucas im Jahre 1707 auf seiner Rückkehr an den französischen Hof begleitet, eine Zeit lang in Paris bleibt und allein zurückkehrt. Die Hinreise führt über den Libanon, Zypern, Nordafrika und Italien, die Rückkehr nach einer Schiffsreise über das Mittelmeer durch Kleinasien. Der Text versammelt viele Topoi, die aus anderen arabischen Reisetexten bekannt sind: Seesturm, Schiffbruch und Piraten, zerstörte Gebäude und wunderschöne Gärten. Ebenso enthält er Anekdoten, Legenden und Episoden, die vermutlich zum Staunen anregen sollen sowie Frömmigkeit und Tugenden vermitteln. Das Besondere an dem Text liegt in der Kraft des Erzählens, mit der unterschiedliche Textteile – informative, dokumentarische wie unterhaltsame Abschnitte – zu einer zusammenhängenden Reiseerzählung verwoben werden. Die offensichtliche Einschreibung in eine bestimmte, meist als faktual verstandene Textsorte (riḥla, safra oder siyāḥa) und der Authentizitätsanspruch des Erzählers werden mit einer Neigung zur Fiktionalität kombiniert, die sich besonders in der Hervorhebung einzigartiger (Selbst-)Erlebnisse äußert. In dem Vortrag sollen die verschiedenen Facetten von Diyābs siyāḥa als erste Ergebnisse eines close reading des Textes präsentiert werden. Es wird dabei der Arbeitshypothese des Dissertationsprojekts nachgegangen: Die siyāḥa lässt sich als eine Kompilation verschiedener Textsorten, Themen und Schreibweisen interpretieren und liefert daher einen Zugang zu Wissenshorizonten und Wissensordnungen im Aleppo des 18. Jahrhunderts. Ziel ist es allerdings auch, das Funktionieren und den Zweck dieses Textes als individuelles literarisches Ereignis zu bestimmen. In diesem Sinne soll schließlich diskutiert werden, in welcher Hinsicht diese siyāḥa als Bildungsroman verstanden werden kann.

Kaposi's Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era

The incidence of Kaposi's Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV-infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time-updated CD4 cell counts and HIV-1 RNA. A total of 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person-years follow-up 162 patients developed KS. The incidence was 1,682/100,000 person-years (95% confidence interval [CI] 1,406-2,011) among patients not receiving ART and 138/100,000 person-years (95% CI 102-187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13-0.28). Low CD4 cell counts (time-updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9-80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to prevent KS and KS-associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV.