BACKGROUND: The increasing global burden of tuberculosis (TB) is linked to human immunodeficiency virus (HIV) infection. METHODS: We reviewed data from notifications of TB cases, cohort treatment outcomes, surveys of Mycobacterium tuberculosis infection, and HIV prevalence in patients with TB and other subgroups. Information was collated from published literature and databases held by the World Health Organization (WHO), the Joint United Nations Programme on HIV/Acquired Immunodeficiency Syndrome (UNAIDS), the US Census Bureau, and the US Centers for Disease Control and Prevention. RESULTS: There were an estimated 8.3 million (5th-95th centiles, 7.3-9.2 million) new TB cases in 2000 (137/100,000 population; range, 121/100,000-151/100,000). Tuberculosis incidence rates were highest in the WHO African Region (290/100,000 per year; range, 265/100,000-331/100,000), as was the annual rate of increase in the number of cases (6%). Nine percent (7%-12%) of all new TB cases in adults (aged 15-49 years) were attributable to HIV infection, but the proportion was much greater in the WHO African Region (31%) and some industrialized countries, notably the United States (26%). There were an estimated 1.8 million (5th-95th centiles, 1.6-2.2 million) deaths from TB, of which 12% (226 000) were attributable to HIV. Tuberculosis was the cause of 11% of all adult AIDS deaths. The prevalence of M tuberculosis-HIV coinfection in adults was 0.36% (11 million people). Coinfection prevalence rates equaled or exceeded 5% in 8 African countries. In South Africa alone there were 2 million coinfected adults. CONCLUSIONS: The HIV pandemic presents a massive challenge to global TB control. The prevention of HIV and TB, the extension of WHO DOTS programs, and a focused effort to control HIV-related TB in areas of high HIV prevalence are matters of great urgency.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/215525/ira20017.pdf

The growing burden of tuberculosis: global trends and interactions with the HIV epidemic.

The ‘risk environment’: a framework for understanding and reducing drug-related harm

https://www.jhsph.edu/research/affiliated-programs/baltimore-neighborhood-research-consortium/research_libr/rhodes2005.pdf

The social structural production of HIV risk among injecting drug users.

Mature, infectious HIV-1 particles contain a characteristic cone-shaped core that encases the viral RNA and replication proteins. The architectures of mature virions and isolated cores were studied using cryo-electron microscopy. The average size ( approximately 145 nm) of the virion was unchanged during maturation. Most virions contained a single core but roughly one-third contained two or more cores. Consideration of the capsid protein concentration during core assembly indicated that core formation in vivo is template-mediated rather than concentration-driven. Although most cores were conical, 7% were tubular. These displayed a stacked-disc arrangement with 7-, 8-, 9- or 10-fold axial symmetry. Layer line filtration of these images showed that the capsid subunit arrangement is consistent with a 9.6 nm hexamer resembling that previously seen in the helical tubes assembled from purified capsid protein. A common reflection (1/3.2 nm) shared between the tubular and conical cores suggested they share a similar organization. The extraordinary flexibility observed in the assembly of the mature core appears to be well suited to accommodating variation and hence there may be no single structure for the infectious virion.

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Structural organization of authentic, mature HIV-1 virions and cores.

As intracellular parasites, viruses rely heavily on the use of numerous cellular machineries for completion of their replication cycle. The recent discovery of the heterogeneous distribution of the various lipids within cell membranes has led to the proposal that sphingolipids and cholesterol tend to segregate in microdomains called membrane rafts. The involvement of membrane rafts in biosynthetic traffic, signal transduction, and endocytosis has suggested that viruses may also take advantage of rafts for completion of some steps of their replication cycle, such as entry into their cell host, assembly, and budding. In this review, we have attempted to delineate all the reliable data sustaining this hypothesis and to build some models of how rafts are used as platforms for assembly of some viruses. Indeed, if in many cases a formal proof of raft involvement in a virus replication cycle is still lacking, one can reasonably suggest that, owing to their ability to specifically attract some proteins, lipid microdomains provide a particular milieu suitable for increasing the efficiency of many protein-protein interactions which are crucial for virus infection and growth.

https://hal.archives-ouvertes.fr/hal-02147208/document

Virus Entry, Assembly, Budding, and Membrane Rafts

Objective To describe recent patterns and trends in the HIV epidemic in eastern Europe. Methods AIDS programme managers and epidemiologists of 23 countries were contacted and requested to provide national HIV surveillance data. Joint United Nations Programme on HIV/AIDS/World Health Organisation country fact sheets were reviewed and analysed, and this information was supplemented with published HIV prevalence and sexually transmitted disease case reporting information, unpublished travel reports and expert evaluations. Results The cumulative number of HIV cases reported in the region increased more than fivefold between 1995 and 1997, from 9111 to 46573; Ukraine, Russia and Belarus accounted for about 90% of all new cases. Dramatic increases in the number of HIV-infected injecting drug users (IDU) were reported from these countries, and a similar pattern was emerging in Moldova, the Baltic States, the Caucasus and Kazakstan. In central Europe, the increase in the number of cases was much lower, and (with the exception of Poland) homosexual transmission was most common, whereas in the Balkan countries, cases due to heterosexual transmission were reported relatively more frequently. At the end of 1997, more than 50% of all cases region-wide had been reported from IDU. HIV prevalence data were inconclusive. The number of reported syphilis cases had risen significantly in the countries of the former Soviet Union. Conclusion Our data confirm that HIV must have been rapidly spreading among IDU in several countries of the former Soviet Union, whereas central and southeast Europe have so far escaped a more extensive spread of HIV. Factors that might have fuelled a massive spread among IDU include changes in drug demand and supply, migration and specific local drug production and consumption patterns. High rates of syphilis reported in the countries of the former Soviet Union highlight that subregion's increased vulnerability with regards to a further spread of the epidemic, via heterosexual intercourse, into the general population.

The HIV/AIDS epidemic in eastern Europe : recent patterns and trends and their implications for policy-making

Update on the epidemics of HIV and other sexually transmitted infections in the newly independent states of the former Soviet Union.

Injecting drug users (IDUs) should be considered a 'partially hidden population' at high risk for HIV infection. In almost all locations it should be possible to locate and conduct research with IDUs, but it will probably never be possible to enumerate or draw random samples from an IDU population. Surveillance research studies with IDUs should include risk behaviors, as surveillance of HIV infection only will not be sufficiently time sensitive, and be used to develop and refine HIV prevention programming for the population. Contacts with IDUs can be developed at multiple settings, including voluntary treatment programs, law enforcement settings, and through 'street outreach.' Each type of setting has different advantages, disadvantages and ethical concerns. HIV testing as part of surveillance also raises additional important ethical concerns. The primary risk behaviors that should be included in surveillance studies are 'sharing' of drug injection equipment, the potential for rapid partner change among risk partners, and sexual risk behavior. Additional important objectives for surveillance research include: (1) the size of the local IDU population, (2) patterns of drug use, (3) availability injection equipment, (4) participation in prevention activities, and (5) access to and use of anti-retroviral treatments. HIV incidence is an ultimate objective for surveillance research, but there are no currently available cost-efficient methods for studying HIV incidence, so estimation from indirect measurements is usually required.

HIV surveillance among injecting drug users.

This paper describes the patterns and trends in HIV and injecting drug use (IDU) in eastern Europe and establishes the possible determinants of the growing HIV/AIDS epidemic among injecting drug users in the Newly Independent States (NIS). It attempts to establish the link between HIV infection and injecting drug use in response to the much-needed development of effective public health policies and programs to combat the epidemic. Five countries have been identified with positive outbreaks specifically Belarus Kazakhstan Moldova Russia and Ukraine with the latter accounting for the vast majority of the reported cases. Several socioeconomic and behavioral factors have contributed to the rapid spread such as substantial increase in IDU populations high unemployment rates and changing migration patterns. The course of the NIS epidemic is largely dependent on drug injecting trends and the success of harm reduction programs and policies to counteract the problem especially with the increasing potential for further spread of HIV to the general population through heterosexual intercourse.

The HIV/AIDS Epidemic among Drug Injectors in Eastern Europe: Patterns, Trends and Determinants

Knowledge and use of abortifacients were investigated in a remote ethnically heterogeneous area in the north of Burkina Faso. A questionnaire survey was carried out among 320 married women in 21 villages and supplemented with key informants' interviews, clinical observations at the provincial hospital, and observations in one of the villages. Almost half of the sampled women of all ethnic groups admitted to the existence of abortion carried out by their peers. Response rates and knowledge of abortions were lower among younger women and among those belonging to the Islamic Hamallist and Wahabiya sects. Abortions were commonly induced by drinking a watery solution of the roots and leaves of a commonly found bush –– Securidaca longepedunculata . The plant contains uterine contraction stimulating ergot-alkaloids, but also strychnine-like toxic substances. It is reportedly effective in provoking abortions within one day of treatment, but its side-effects are severe and include heavy vaginal bleeding, abdominal pain, diarrhoea and vomiting, and death. There is a need for the rapid introduction of safer birth control methods in the region. (Afr J Reprod Health 1999; 3[2]: 40-50) Key Words: Burkina Faso, Fulbe, Gurmance, abortion, abortifacients, ergot-alkaloids

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Karl L. Dehne

Papers

The HIV/AIDS epidemic in eastern Europe : recent patterns and trends and their implications for policy-making

Update on the epidemics of HIV and other sexually transmitted infections in the newly independent states of the former Soviet Union.

HIV surveillance among injecting drug users.

The HIV/AIDS Epidemic among Drug Injectors in Eastern Europe: Patterns, Trends and Determinants

Abortion in the North of Burkina Faso