Transferrin polymorphism and opportunistic infections in HIV-infected women in Rwanda

&lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; We investigated the prevalence of opportunistic infections in HIV-infected women according to transferrin (TF) phenotype. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We conducted a cross-sectional study among 200 HIV-positive women in the Butare University Teaching Hospital in Rwanda. TF phenotypes were determined using starch gel electrophoresis. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Phenotype frequencies of TF CD, CB and CC were 14.5, 3 and 82.5%, respectively. The homozygous TF DD phenotype was not found. Subjects with TF CD phenotype had a significantly higher prevalence of opportunistic infections than subjects with TF CC phenotype, 76 and 52%, respectively (p = 0.026). In logistic regression, there was a significant correlation between TF phenotypes and opportunistic infections (p = 0.012). Subjects with TF CD phenotype had significantly lower values for TF (p = 0.006) than TF CC subjects. Hematological parameters (RBC, RBC indices, hemoglobin, hematocrit, WBC, neutrophils, lymphocytes, platelets and erythrocyte sedimentation rate), iron, ferritin, TF saturation, C-reactive protein and CD4 count did not differ according to TF phenotype. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Subjects with TF CC phenotype have a lower prevalence of opportunistic infections. Iron status may play a role in this association.</jats:p

Ferroportin (SLC40A1) Q248H mutation is associated with lower circulating serum hepcidin levels in Rwandese HIV-positive women

The Q248H mutation in the gene SLC40A1 which encodes for the cellular iron exporter ferroportin is relatively common in Africa. This mutation has been associated with resistance to hepcidin and therefore we hypothesized that iron-related parameters and the prevalence of opportunistic infections in HIV might be influenced by the Q248H mutation. We conducted a cross-sectional study among 200 HIV-positive women in the Butare University Teaching Hospital in Rwanda. Polymerase chain reaction (PCR) and restriction enzyme digestion were used to identify the Q248H mutation. Physical examination was carried out and WHO HIV disease stage classification, complete blood count, CD4 count, indirect measures of iron status, serum hepcidin, and C-reactive protein concentrations were determined. The prevalence of ferroportin Q248H mutation was 6%. Subjects with ferroportin Q248H mutation had significantly higher values for serum ferritin ( = 0.001) and significantly lower values for serum hepcidin ( = 0.001) and transferrin ( = 0.01). Among the 12 HIV + Q248H heterozygotes, 8 suffered from at least one opportunistic infection. There was significantly higher prevalence of pulmonary TB ( = 0.01) and pneumonia ( = 0.02) in subjects with ferroportin Q248H mutation. Low hepcidin levels were found in ferroportin Q248H heterozygotes with HIV infection, notwithstanding the absence of anemia and the higher prevalence of some opportunistic infections. Hepcidin seems to be regulated in a different way in Q248H heterozygotes than is known thus far

Treatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence.

Severe anaemia is a common presentation in non-pregnant adults admitted to hospital in southern Africa. Standard syndromic treatment based on data from the pre-HIV era is for iron deficiency, worms and malaria. We prospectively investigated 105 adults admitted consecutively to medical wards with haemoglobin < 7 g/dl. Those with acute blood loss were excluded. Patients were investigated for possible parasitic, bacterial, mycobacterial and nutritional causes of anaemia, including bone marrow aspiration, to identify potentially treatable causes. Seventy-nine per cent of patients were HIV-positive. One-third of patients had tuberculosis, which was diagnosed only by bone marrow culture in 8% of HIV-positive patients. In 21% of individuals bacteria were cultured, with non-typhi salmonella predominating and Streptococcus pneumoniae rare. Iron deficiency, hookworm infection and malaria were not common in HIV-positive anaemic adults, although heavy hookworm infections were found in 6 (27%) of the 22 HIV-negative anaemic adults. In conclusion, conventional treatment for severe anaemia in adults is not appropriate in an area of high HIV prevalence. Occult mycobacterial disease and bacteraemia are common, but iron deficiency is not common in HIV-positive patients. In addition to iron supplements, management of severe anaemia should include investigation for tuberculosis, and consideration of antibiotics active against enterobacteria

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

To determine the prevalence and risk factors of anemia among human immunodeficiency virus (HIV)–infected women in Rwanda and the influence of highly active antiretroviral therapy (HAART) on anemia, we analyzed 200 HIV-positive women and 50 HIV-negative women in a cross-sectional study. Clinical examinations and iron and vitamin B12 assays were performed, and complete blood counts, serum folic acid levels, and CD4 cell count determined. The prevalence of anemia was significantly higher among HIV-positive women (29%) than among HIV-negative women (8%) (P < 0.001). Risk factors for anemia were lower body mass index (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 2.4–4.1), zidovudine use (OR = 1.14, 95% CI = 1.01–1.29), lack of HAART (OR = 1.44, 95% CI = 1.21–1.67), oral candidiasis (OR = 1.4, 95% CI = 1.2–1.6), pulmonary tuberculosis (OR = 1.8, 95% CI = 1.7–2.2), cryptococcal meningitis (OR = 1.6, 95% CI = 1.21–1.8), Pneumocystis jiroveci pneumonia (OR = 1.41, 95% CI = 1.20–1.65) and CD4 lymphocyte count < 200 cells/μL (OR = 2.41, 95% CI = 2.01–3.07). The mean ± SD hemoglobin level of 10.9 ± 1.6 g/dL at HAART initiation significantly increased to 12.3 ± 1.5 g/dL in 8 months (P < 0.001). Anemia increases with HIV stage, and HAART is associated with a significant improvement in hemoglobin levels

Creating Dependency: Land and Gift-giving Practices in Uganda

President Museveni's re-election in February 2011 demonstrated once more the skills of the Ugandan leader to remain in control ever since he took over power in 1986 heading a guerrilla movement. Some of the campaign themes dealt with land and administration, others with security and the role of the armed forces in bringing back peace to the country. Museveni's populist stance in favour of squatters, in places where user rights are threatened by the progress of individual titling, came out prominently. Actual gifts and many promises of money, land, new districts as well as offers of protection were made during the campaign. These were meant to foster moral indebtedness and political support for the regime and its leader, making it difficult to break off from such an uneven relationship. This paper focuses on the double-edged politics of dependency and protection in Uganda