Petrogenesis of dunite, wehrlite and websterite xenoliths from Kimberley, South Africa: Origin as mantle peridotites of cumulates

Dunite, wehrlite and websterite xenoliths occur amongst a large abundance of mantle xenoliths in kimberlites of the Kimberley cluster in South Africa. Up to know they have mostly been neglected. On the basis of texture, major and trace elements, oxygen isotopes as well as Re-Os isotope characteristics, they can be subdivided into two groups. A coarse-grained mantle peridotite group, comprising dunite, wehrlite and websterite xenoliths, that are similar to fertile peridotites and represent upper mantle assemblages that are differently influenced by mantle metasomatism. And a cumulate group, containing fine-grained Fe-rich dunite xenoliths that represent cumulates of flood basalt magmatism related to ~183 Ma Karoo and ~2.7 Ga Ventersdorp events in southern Africa. Dunite, wehrlite and websterite xenoliths have preserved a complex history of melt depletion and metasomatic re-enrichment events, which gives information about the different re-enrichment stages of the subcratonic lithospheric mantle and the spatial differences within the Kaapvaal craton upper mantle. Websterite xenoliths comprise orthopyroxene (40-85 Vol. %), clinopyroxene (5-42 Vol. %), garnet (4-10 Vol. %) and subordinately olivine, while dunite and wehrlite xenoliths contain predominantly olivine (65-100 Vol %) and subordinately orthopyroxene, clinopyroxene and garnet. High melt depletion and a dunitic to harzburgitic protolith composition are reflected by high forsterite (Fo90-92) and high olivine NiO contents (2800-5000 ppm) and high orthopyroxene Mg# (Mg/(Mg+Fe)) of 0.91-0.93. Re-depletion ages of predominantly 2.9 Ga reflect a minimum age of melt depletion. Melt depletion ceased in conjunction with collision of the Kimberley block with the Witwatersrand block ~2.9 Ga ago. Subduction related re-fertilisation of the previously depleted mantle xenoliths is documented by i) amoeboid textured orthopyroxene, clinopyroxene and garnet, which crystallized in schlieren along olivine grain boundaries, ii) high whole-rock SiO2, Al2O3, CaO, TiO2, FeO contents, iii) low oxygen isotope ratios in clinopyroxene and garnet of 4.8-5.4 ‰ and 4.7-5.3 ‰, respectively and iv) trace element compositions of wehrlitic clinopyroxene and garnet in equilibrium with high-pressure partial melts of eclogite. Trace element disequilibrium of orthopyroxene with clinopyroxene and garnet indicates a separate origin for orthopyroxene, on one side as primary mantle orthopyroxene in dunite and wehrlite xenoliths and on the other side as reaction product with Si-rich melts produced by partial melting of eclogite. This reaction triggered replacement of olivine by orthopyroxene in the surrounding mantle and produced the typical Si-rich composition of Kaapvaal mantle peridotites. Partial melting of eclogite at higher temperatures produced a second metasomatic melt with lower SiO2, but higher Al2O3, CaO, FeO, Ti, Zr, Hf and a low oxygen isotope ratio. This melt triggered clinopyroxene and locally garnet and rutile crystallization in percolation veins, replacing olivine and orthopyroxene in the Kaapvaal upper mantle. Additionally, websterite xenoliths have experienced late stage cryptic metasomatism by the host kimberlite melt, changing the trace element composition of clinopyroxene, orthopyroxene and garnet to different extent. Hence websterite and most fertile lherzolite xenoliths have experienced three metasomatic events: i) reaction with high-Si melt, ii) percolation of subduction related silica melt with lower SiO2 content and iii) cryptic metasomatism by kimberlite. In contrast, dunite and wehrlite xenoliths have only experienced the second metasomatic event. They represent mantle lithologies further away from metasomatising agents. The Fe-rich dunites comprise olivine neoblasts with subordinate olivine porphyroclasts and parallel-orientated needles of ilmenite, which may enclose spinel. The lower forsterite and NiO contents of olivine in Fe-rich dunites compared to mantle peridotite xenoliths (Fo87-89 vs. Fo93-95 and 1300-2800ppm vs. 2200-3900 ppm, respectively), rules out a restitic origin. Cr-rich spinels are remnants of the original cumulate mineralogy that survived a late stage metasomatic overprint related to the production of the host kimberlite, producing ilmenite and phlogopite in some samples. Olivine porphyroclasts and neoblasts have different trace element compositions, the latter having high Ti, V, Cr and Ni and low Zn, Zr and Nb contents, indicating contrasting origins for neoblasts and porphyroclasts. The dunites have high 187Os/188Os ratios (0.11-0.15) indicating young (Phanerozoic) model ages for most samples, whereas three samples show isotopic mixtures between Phanerozoic neoblasts and ancient porphyroclastic material. Most Fe-rich dunite xenoliths can be interpreted as cumulates of fractional crystallization of Karoo magmatism, whereas the porphyroclasts are interpreted to be remnants from the much earlier Archaean Ventersdorp magmatism.

Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study

Objective: In South Africa, many HIV-infected patients experience delays in accessing antiretroviral therapy (ART). We examined pretreatment mortality and access to treatment in patients waiting for ART. Design: Cohort of HIV-infected patients assessed for ART eligibility at 36 facilities participating in the Comprehensive HIV and AIDS Management (CHAM) program in the Free State Province. Methods: Proportion of patients initiating ART, pre-ART mortality and risk factors associated with these outcomes were estimated using competing risks survival analysis. Results: Forty-four thousand, eight hundred and forty-four patients enrolled in CHAM between May 2004 and December 2007, of whom 22 083 (49.2%) were eligible for ART; pre-ART mortality was 53.2 per 100 person-years [95% confidence interval (CI) 51.8–54.7]. Median CD4 cell count at eligibility increased from 87 cells/ml in 2004 to 101 cells/ml in 2007. Two years after eligibility an estimated 67.7% (67.1–68.4%) of patients had started ART, and 26.2% (25.6–26.9%) died before starting ART. Among patients with CD4 cell counts below 25 cells/ml at eligibility, 48% died before ART and 51% initiated ART. Men were less likely to start treatment and more likely to die than women. Patients in rural clinics or clinics with low staffing levels had lower rates of starting treatment and higher mortality compared with patients in urban/peri-urban clinics, or better staffed clinics. Conclusions: Mortality is high in eligible patients waiting for ART in the Free State Province. The most immunocompromised patients had the lowest probability of starting ART and the highest risk of pre-ART death. Prioritization of these patients should reduce waiting times and pre-ART mortality.

Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007

Little is known about the temporal impact of the rapid scale-up of large antiretroviral therapy (ART) services on programme outcomes. We describe patient outcomes [mortality, loss-to-follow-up (LTFU) and retention] over time in a network of South African ART cohorts.

"Cutting for love": genital incisions to enhance sexual desirability and commitment in KwaZulu-Natal, South Africa

Several studies have documented women's use of vaginal practices in South Africa to enhance their desirability to men. This article describes a little known practice of this kind among women in KwaZulu-Natal. It involves the use of small incisions in the genital area (and often abdomen and breasts) to introduce herbal substances, described as love medicines, into the body through the incisions. In-depth interviews were carried out with 20 key informants and 20 women, and eight focus group discussions with women and men, in a rural and urban site in 2005-06. A province-wide household survey was then conducted using a multi-stage cluster sample design among 867 women aged 18-60. Forty-two per cent of the women in the household survey had heard of genital incisions; only 3% had actually used them. The main motivation was the enhancement of sexual attractiveness and long-term partner commitment. It appears to be a very recent practice, but may be an extension of an older healing practice not involving the genitals. It was most prevalent among rural women aged 24-29 (although not significant), those with less education, and those who suspected their partners of having other partners. It is linked to the modern popularity of love medicines, which in turn illustrates the troubling state of gender relations in KwaZulu-Natal today.

Rates and Predictors of Failure of First-line Antiretroviral Therapy and Switch to Second-line ART in South Africa

To measure rates and predictors of virologic failure and switch to second-line antiretroviral therapy (ART) in South Africa.

Prevalence and predictors of kaposi sarcoma herpes virus seropositivity: a cross-sectional analysis of HIV-infected adults initiating ART in Johannesburg, South Africa

Background Kaposi sarcoma (KS) is the most common AIDS-defining tumour in HIV-infected individuals in Africa. Kaposi sarcoma herpes virus (KSHV) infection precedes development of KS. KSHV co-infection may be associated with worse outcomes in HIV disease and elevated KSHV viral load may be an early marker for advanced HIV disease among untreated patients. We examined the prevalence of KSHV among adults initiating antiretroviral therapy (ART) and compared immunological, demographic and clinical factors between patients seropositive and seronegative for KSHV. Results We analyzed cross-sectional data collected from 404 HIV-infected treatment-naïve adults initiating ART at the Themba Lethu Clinic, Johannesburg, South Africa between November 2008 and March 2009. Subjects were screened at ART initiation for antibodies to KSHV lytic K8.1 and latent Orf73 antigens. Seropositivity to KSHV was defined as positive to either lytic KSHV K8.1 or latent KSHV Orf73 antibodies. KSHV viremia was determined by quantitative PCR and CD3, 4 and 8 lymphocyte counts were determined with flow cytometry. Of the 404 participants, 193 (48%) tested positive for KSHV at ART initiation; with 76 (39%) reactive to lytic K8.1, 35 (18%) to latent Orf73 and 82 (42%) to both. One individual presented with clinical KS at ART initiation. The KSHV infected group was similar to those without KSHV in terms of age, race, gender, ethnicity, smoking and alcohol use. KSHV infected individuals presented with slightly higher median CD3 (817 vs. 726 cells/mm3) and CD4 (90 vs. 80 cells/mm3) counts than KSHV negative subjects. We found no associations between KSHV seropositivity and body mass index, tuberculosis status, WHO stage, HIV RNA levels, full blood count or liver function tests at initiation. Those with detectable KSHV viremia (n = 19), however, appeared to present with signs of more advanced HIV disease including anemia and WHO stage 3 or 4 defining conditions compared to those in whom the virus was undetectable. Conclusions We demonstrate a high prevalence of KSHV among HIV-infected adults initiating ART in a large urban public-sector HIV clinic. KSHV viremia but not KSHV seropositivity may be associated with markers of advanced HIV disease.

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.

Virologic failure and second-line antiretroviral therapy in children in South Africa--the IeDEA Southern Africa collaboration

Background: With expanding pediatric antiretroviral therapy (ART) access, children will begin to experience treatment failure and require second-line therapy. We evaluated the probability and determinants of virologic failure and switching in children in South Africa. Methods: Pooled analysis of routine individual data from children who initiated ART in 7 South African treatment programs with 6-monthly viral load and CD4 monitoring produced Kaplan-Meier estimates of probability of virologic failure (2 consecutive unsuppressed viral loads with the second being >1000 copies/mL, after ≥24 weeks of therapy) and switch to second-line. Cox-proportional hazards models stratified by program were used to determine predictors of these outcomes. Results: The 3-year probability of virologic failure among 5485 children was 19.3% (95% confidence interval: 17.6 to 21.1). Use of nevirapine or ritonavir alone in the initial regimen (compared with efavirenz) and exposure to prevention of mother to child transmission regimens were independently associated with failure [adjusted hazard ratios (95% confidence interval): 1.77 (1.11 to 2.83), 2.39 (1.57 to 3.64) and 1.40 (1.02 to 1.92), respectively]. Among 252 children with ≥1 year follow-up after failure, 38% were switched to second-line. Median (interquartile range) months between failure and switch was 5.7 (2.9-11.0). Conclusions: Triple ART based on nevirapine or ritonavir as a single protease inhibitor seems to be associated with a higher risk of virologic failure. A low proportion of virologically failing children were switched.

Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry

Vaginal practices in sub-Saharan Africa may increase HIV transmission and have important implications for development of microbicides and future HIV prevention technologies. It remains unclear which women undertake vaginal practices and what factors predict prevalence, practice type and choice of products. Using cross-sectional data from mixed research methods, we identify factors associated with vaginal practices among women in KwaZulu-Natal, South Africa. Data were gathered through focus group discussions, in-depth and key-informant interviews, followed by a province-wide, multi-stage cluster household survey, using structured questionnaires in face-to-face interviews with 867 women. This paper details six types of vaginal practices, which--despite their individual distinctiveness and diverse motivations--may be clustered into two broad groups: those undertaken for purposes of 'hygiene' (genital washing, douching and application) and those for 'sexual motivations' (application, insertion, ingestion and incisions). Multivariate analysis found significant associations between 'hygiene' practices and media access, religiosity and transactional sex. 'Sexual' practices were associated with partner concurrency, religiosity and use of injectable hormonal contraceptives. Future interventions relating to vaginal practices as well as microbicides need to reflect this characterisation of practices as sexual- and/or hygiene-related.

Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study

Background Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART. Methods and Findings Analyses included 46,201 ART-naïve adults starting ART between January 2002 and December 2009 in eight ART programmes across South Africa (SA). Patients were followed from initiation of ART to outcome or analysis closure. The primary outcome was mortality; secondary outcomes were loss to follow-up (LTF), virologic suppression, and CD4+ cell count responses. Survival analyses were used to examine the hazard of death on ART by gender. Sensitivity analyses were limited to patients who were virologically suppressed and patients whose CD4+ cell count reached >200 cells/µl. We compared gender differences in mortality among HIV+ patients on ART with mortality in an age-standardised HIV-negative population. Among 46,201 adults (65% female, median age 35 years), during 77,578 person-years of follow-up, men had lower median CD4+ cell counts than women (85 versus 110 cells/µl, p<0.001), were more likely to be classified WHO stage III/IV (86 versus 77%, p<0.001), and had higher mortality in crude (8.5 versus 5.7 deaths/100 person-years, p<0.001) and adjusted analyses (adjusted hazard ratio [AHR] 1.31, 95% CI 1.22–1.41). After 36 months on ART, men were more likely than women to be truly LTF (AHR 1.20, 95% CI 1.12–1.28) but not to die after LTF (AHR 1.04, 95% CI 0.86–1.25). Findings were consistent across all eight programmes. Virologic suppression was similar by gender; women had slightly better immunologic responses than men. Notably, the observed gender differences in mortality on ART were smaller than gender differences in age-standardised death rates in the HIV-negative South African population. Over time, non-HIV mortality appeared to account for an increasing proportion of observed mortality. The analysis was limited by missing data on baseline HIV disease characteristics, and we did not observe directly mortality in HIV-negative populations where the participating cohorts were located. Conclusions HIV-infected men have higher mortality on ART than women in South African programmes, but these differences are only partly explained by more advanced HIV disease at the time of ART initiation, differential LTF and subsequent mortality, and differences in responses to treatment. The observed differences in mortality on ART may be best explained by background differences in mortality between men and women in the South African population unrelated to the HIV/AIDS epidemic.