Makerere University

About: Makerere University is a education organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Public health. The organization has 7220 authors who have published 12405 publications receiving 366520 citations. The organization is also known as: Makerere University Kampala & MUK.

Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review

Abstract: This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5–38.2%, Tau2 = 0.23) and 18% (95% CI 12.3–25.8%, Tau2 = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31–0.66, Tau2 = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.

Trichomonas vaginalis Infection and Human Immunodeficiency Virus Acquisition in African Women

Abstract: Trichomoniasis vaginalis is the most common nonviral sexually transmitted infection (STI) worldwide with a particularly high prevalence in regions of human immunodeficiency virus (HIV) endemicity. However its impact as a cofactor for HIV acquisition is poorly understood. Samples from 213 women who experienced HIV seroconversion (cases) during a longitudinal study involving 4450 women in Uganda and Zimbabwe were matched with samples from HIV-uninfected women (controls). All samples underwent polymerase chain reaction (PCR) analysis for Trichomonas vaginalis DNA. For cases analyzed samples were from the visit in which HIV seroconversion was detected and the visit preceding detection of seroconversion; for controls one analyzed sample was from the visit matched by follow-up duration to the cases seroconversion visit and the other sample was from the visit immediately preceding the matched visit. The prevalence of T. vaginalis infection before HIV infection was 11.3% in cases and 4.5% in controls (P = .002). In multivariable analysis controlling for hormonal contraception other STIs behavioral and demographic factors the adjusted odds ratio for HIV acquisition was 2.74 (95% confidence interval 1.25-6.00) for T. vaginalis-positive cases. The presence of behavioral risk factors for HIV infection study recruitment from a referral population at high-risk for HIV primary sex partner-associated risk for HIV infection and herpes simplex virus type 2 seropositivity were also predictive of incident HIV infection. T. vaginalis infection is strongly associated with an increased risk for HIV infection in this general population of African women. Given the high prevalence of T. vaginalis infection in HIV-endemic areas T. vaginalis control may have a substantial impact on preventing HIV acquisition among women. (authors)

Outcomes of Cryptococcal Meningitis in Uganda Before and After the Availability of Highly Active Antiretroviral Therapy

Abstract: Cryptococcal meningitis (CM) is the proximate cause of death in 20%-30% of persons with acquired immunodeficiency syndrome in Africa. Two prospective observational cohorts enrolled human immunodeficiency virus (HIV)-infected antiretroviral-naive persons with CM in Kampala Uganda. The first cohort was enrolled in 2001-2002 (n = 92) prior to the availability of highly active antiretroviral therapy (HAART) and the second was enrolled in 2006-2007 (n = 44) when HAART was available. Ugandans presented with prolonged CM symptoms (median duration 14 days; interquartile range 7-21 days). The 14-day survival rates were 49% in 2001-2002 and 80% in 2006 (P less than .001). HAART was started 35_13 days after CM diagnosis and does not explain the improved 14-day survival rate in 2006. In 2006-2007 the survival rate continued to decrease after hospitalization with only 55% surviving to initiate HAART as an outpatient. Probable cryptococcal-related immune reconstitution inflammatory syndrome occurred in 42% of patients with 4 deaths. At 6 months after CM diagnosis 18 persons (41%) were alive and receiving HAART in 2007. The median cerebral spinal fluid (CSF) opening pressure was 330 mm H2O; 81% of patients had elevated pressure (greater than 200 mm H2O). Only 5 patients consented to therapeutic lumbar puncture. There was a trend for higher mortality for pressures greater than 250 mm H2O (odds ratio [OR] 2.1; 95% confidence interval [CI] 0.9-5.2; P = .09). Initial CSF WBC counts of less than 5 cells/mL were associated with failure of CSF sterilization (OR 17.3; 95% CI 3.1-94.3; P less than .001) and protein levels less than 35 mg/dL were associated with higher mortality (OR 2.0; 95% CI 1.2-3.3; P = .007). Significant CM-associated mortality persists despite the administration of amphotericin B and HIV therapy because of the high mortality rate before receipt of HAART and because of immune reconstitution inflammatory syndrome-related complications after HAART initiation. Approaches to increase acceptance of therapeutic lumbar punctures are needed. (authors)

Effect of Human Immunodeficiency Virus Type 1 (HIV-1) Subtype on Disease Progression in Persons from Rakai, Uganda, with Incident HIV-1 Infection

Abstract: Human immunodeficiency virus type 1 (HIV-1) subtypes differ in biological characteristics that may affect pathogenicity. We determined the HIV-1 subtype-specific rates of disease progression among 350 HIV-1 seroconverters. Subtype viral load and CD4+ cell count were determined. Cox proportional hazards regression modeling was used to estimate adjusted hazard ratios (HRs) of progression to acquired immunodeficiency syndrome (AIDS) (defined as a CD4+ cell count of less than or equal to 250 cells/mm3) and to AIDS-associated death. A total of 59.1% of study subjects had subtype D strains 15.1% had subtype A 21.1% had intersubtype recombinant subtypes 4.3% had multiple subtypes and 0.3% had subtype C. Of the 350 subjects 129 (37%) progressed to AIDS and 68 (19.5%) died of AIDS. The median time to AIDS onset was shorter for persons with subtype D(6.5 years) recombinant subtypes (5.6 years) or multiple subtypes (5.8 years) compared with persons with subtype A (8.0 years; P = .022). Relative tosubtype A adjusted HRs of progression to AIDS were 2.13 [95% confidence interval {CI} 1.10-4.11] for subtype D 2.16 [95% CI 1.05-4.45] for recombinant subtypes and 4.40 [95% CI 1.71-11.3] for multiple subtypes. The risk of progression to death was significantly higher for subtype D (adjusted HR 5.65; 95% CI 1.37-23.4) recombinant subtypes (adjusted HR 6.70; 95% CI 1.56-28.8) and multiple subtypes (adjusted HR 7.67; 95% CI 1.27-46.3) compared with subtype A. HIV disease progression is affected by HIV-1 subtype. This finding may impact decisions on when to initiate antiretroviral therapy and may have implications for future trials of HIV-1 vaccines aimed at slowing disease progression. (authors)