Publications


2017

Bork, KA, Cames C, Newell M-L, Read JS, Ayassou K, Musyoka F, Mbatia G, Cournil A.  2017.  Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study., 2017 Mar. The Journal of nutrition. 147(3):453-461. Abstract

Background: Early feeding patterns may affect the growth of HIV-exposed children and thus their subsequent health and cognition.Objective: We assessed the association of infant feeding (IF) mode with length-for-age z score (LAZ) and stunting from age 2 d to 18 mo in HIV-exposed African children within a controlled randomized trial, which evaluated triple antiretrovirals initiated during pregnancy and continued for 6 mo postpartum to prevent HIV transmission.Methods: HIV-infected pregnant women with CD4(+) counts of 200-500 cells/mm(3) from Burkina Faso, Kenya, and South Africa were advised to exclusively breastfeed for up to 6 mo or to formula-feed from birth. Factors associated with LAZ were investigated in all uninfected children by using mixed-effects linear models; those associated with stunting (LAZ <-2) at 6 or 12 mo were assessed in multiple logistic regression after exclusion of children stunted at age 2 d. Independent variables were IF mode: formula feeding (FF), exclusive breastfeeding (EBF) <3 mo, or EBF ≥3 mo (reference); sex; trial arm; maternal characteristics; and site.Results: Among 728 children, FF was associated with a greater increase in LAZ from 2 d to 6 mo (+0.07 z score/mo, P < 0.001). Between 6 and 18 mo, FF and EBF <3 mo were both associated with greater mean LAZ than was EBF ≥3 mo (+0.52 z scores and +0.43 z scores, respectively, P < 0.001). Among children not stunted at 2 d, FF was independently associated with a reduced risk of stunting at 6 mo (OR: 0.24; 95% CI: 0.07, 0.81; P = 0.021), whereas EBF <3 mo was not (OR: 0.49; 95% CI: 0.22, 1.10; P = 0.09).Conclusions: In this observational study of HIV-exposed uninfected infants, growth in length in the first 6 mo of life was faster in formula-fed infants than in exclusively breastfed infants. The plausibility of residual confounding and reverse causality is discussed. This trial was registered at www.controlled-trials.com as ISRCTN71468401.

2015

Cournil, A, Van de Perre P, Cames C, de Vincenzi I, Read JS, Luchters S, Meda N, Naidu K, Newell M-L, Bork K.  2015.  Early infant feeding patterns and HIV-free survival: findings from the Kesho-Bora trial (Burkina Faso, Kenya, South Africa)., 2015 Feb. The Pediatric infectious disease journal. 34(2):168-74. Abstract

To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral (ARV) prophylaxis modifies the association.

2014

Cames, C, Cournil A, de Vincenzi I, Gaillard P, Meda N, Luchters S, Ruth Nduati, Naidu K, Newell M-L, Read JS, Bork K.  2014.  Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting., 2014 Jan 02. AIDS (London, England). 28(1):85-94. Abstract

To assess the relationship between infant feeding, triple-antiretroviral prophylaxis and weight from 2 weeks (baseline) to 6 months postpartum among HIV-infected mothers in a mother-to-child transmission (MTCT) of HIV-prevention trial in five sub-Saharan African sites.

Bork, KA, Cournil A, Read JS, Newell M-L, Cames C, Meda N, Luchters S, Mbatia G, Naidu K, Gaillard P, de Vincenzi I.  2014.  Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho Bora study., 2014 Dec. The American journal of clinical nutrition. 100(6):1559-68. Abstract

Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.

2013

Bork, K, Cames C, Cournil A, Musyoka F, Ayassou K, Naidu K, Mepham S, Christine Gichuhi, Dalton Wamalwa, Read JS, Gaillard P, de Vincenzi I.  2013.  Infant feeding modes and determinants among HIV-1-infected African Women in the Kesho Bora Study., 2013 Jan 01. Journal of acquired immune deficiency syndromes (1999). 62(1):109-18. Abstract

To assess breastfeeding modes and determinants in a prevention of mother-to-child transmission study.

Cournil, A, de Vincenzi I, Gaillard P, Cames C, Fao P, Luchters S, Rollins N, Newell M-L, Bork K, Read JS.  2013.  Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: the Kesho Bora study., 2013 Jun 19. AIDS (London, England). 27(10):1621-30. Abstract

To assess the relationship between infant feeding practices and mortality by 18 months of age among children born to HIV-infected mothers in the Kesho Bora trial (Burkina-Faso, Kenya and South Africa).

Mwau, M, Adungo F, Kadima S, Njagi E, Kirwaye C, Abubakr NS, Okubi LA, Waihenya M, Lusike J, Hungu J.  2013.  Evaluation of PIMA™® point of care technology for CD4 T cell enumeration in Kenya., 2013. PloS one. 8(6):e67612. Abstract

CD4+ T cell enumeration is used to determine eligibility for antiretroviral therapy (ART) and to monitor the immune status of HIV-positive patients; however, many patients do not have access to this essential diagnostic test. Introducing point of care (POC) testing may improve access. We have evaluated Alere's PIMA™, one such POC device, against conventional CD4+ testing platforms to determine its performance and validity for use in Kenya. In our hands, Alere PIMA™ had a coefficient of variability of 10.3% and of repeatability of 175.6 cells/µl. It differed from both the BD FACSCalibur™ (r(2) = 0.762, mean bias -64.8 cells/µl), and the BD FACSCount™ (r(2) = 0.874, mean bias 7.8 cells/µl). When compared to the FACSCalibur™ at a cutoff of 350 cells/µl, it had a sensitivity of 89.6% and a specificity of 86.7% in those aged 5 years and over (Kw = 0.7566). With the BD FACSCount™, it had a sensitivity of 79.4% and a specificity of 83.4% in those aged 5 years and over (Kw = 0.7790). The device also differed from PARTEC Cyflow™ (r(2) = 0.781, mean bias -24.2 cells/µl) and GUAVA™ (r(2) = 0.658, mean bias -0.3 cells/µl) platforms, which are used in some facilities in Kenya. We conclude that with refinement, Alere PIMA™ technology has potential benefits for HIV-positive patients. This study highlights the difficulty in selecting the most appropriate reference technology for technical evaluations.

2012

Kesho Bora Study Group.  2012.  Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen (triple-antiretroviral prophylaxis during pregnancy and breastfeeding, 2012 Aug. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 55(3):449-60. Abstractcis461.pdf

Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs.

Kesho Bora Study Group.  2012.  Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen , 2012 Aug. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 55(3):449-60. Abstract

Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs.

Irungu, E, Chersich MF, Sanon C, Chege R, Gaillard P, Temmerman M, Read JS, Luchters S.  2012.  Changes in sexual behaviour among HIV-infected women in west and east Africa in the first 24 months after delivery., 2012 May 15. AIDS (London, England). 26(8):997-1007. Abstract

Describe changes in sexual behaviour and determinants of unsafe sex among HIV-infected women in the 24 months after delivery.

2011

Kesho Bora Study Group.  2011.  Safety and effectiveness of antiretroviral drugs during pregnancy, delivery and breastfeeding for prevention of mother-to-child transmission of HIV-1: the Kesho Bora Multicentre Collaborative Study rationale, design, and implementation challenges., 2011 Jan. Contemporary clinical trials. 32(1):74-85. Abstract

To evaluate strategies to reduce HIV-1 transmission through breastfeeding, a multicentre study including a nested randomized controlled trial was implemented in five research sites in West, East and South Africa (The Kesho Bora Study). The aim was to optimize the use of antiretroviral (ARV) drugs during pregnancy, delivery and breastfeeding to prevent mother-to-child transmission of HIV-1 (PMTCT) and to preserve the health of the HIV-1-infected mother. The study included long-term ARV treatment for women with advanced disease, and short-course ARV prophylaxis stopped at delivery for women with early disease. Women with intermediate disease participated in a randomized controlled trial to compare safety and efficacy of triple-ARV prophylaxis prolonged during breastfeeding with short-course ARV prophylaxis stopped at delivery. Between January 2005 and August 2008 a total of 1140 women were enrolled. This paper describes the study design, interventions and protocol amendments introduced to adapt to evolving scientific knowledge, international guidelines and availability of ARV treatment. The paper highlights the successes and challenges during the conduct of the trial. The Kesho Bora Study included one of the few randomized controlled trials to assess safety and efficacy of ARV prophylaxis continued during breastfeeding and the only randomized trial to assess maternal prophylaxis started during pregnancy. The findings have been important for informing international and national guidelines on MTCT prevention in developing countries where, due to poverty, lack of reliable and affordable supply of replacement feed and stigma associated with HIV/AIDS, HIV-infected women have little or no option other than to breastfeed their infants. (ISRCTN71468401).

de Vincenzi, I.  2011.  Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial., 2011 Mar. The Lancet. Infectious diseases. 11(3):171-80. Abstract

Breastfeeding is essential for child health and development in low-resource settings but carries a significant risk of transmission of HIV-1, especially in late stages of maternal disease. We aimed to assess the efficacy and safety of triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis in pregnant women infected with HIV.

2010

Rouet, F, Foulongne V, Viljoen J, Steegen K, Becquart P, Valéa D, Danaviah S, Segondy M, Verhofstede C, Van de Perre P.  2010.  Comparison of the Generic HIV Viral Load assay with the Amplicor HIV-1 monitor v1.5 and Nuclisens HIV-1 EasyQ v1.2 techniques for plasma HIV-1 RNA quantitation of non-B subtypes: the Kesho Bora preparatory study., 2010 Feb. Journal of virological methods. 163(2):253-7. Abstract

The implementation of cost effective HIV-1 RNA quantitation assays in resource-poor settings is of paramount importance for monitoring HV-1 infection. A study comparing the analytical performance of three HIV-1 RNA assays (Generic HIV Viral Load, Amplicor v1.5 and Nuclisens EasyQ v1.2) was performed on 160 plasma samples from 160 consecutive antiretroviral treatment naive HIV-1-infected pregnant women assessed for eligibility in the Kesho Bora trial aimed at prevention of mother-to-child transmission of HIV-1 in three African countries (Burkina Faso, Kenya and South Africa). Correlation and agreement of results of the three assays were assessed for plasma HIV-1 RNA quantitation in specimens harbouring mainly sub-subtype A1, subtype C, and circulating recombinant form (CRF) 02_AG and CRF06_cpx. Good degrees of correlation and agreement were observed between these HIV-1 RNA assays. However, nine (9/160, 5.6%) strains detectable with the Generic HIV Viral Load assay were not detected by either the Amplicor (n=7) or EasyQ (n=2) test. One strain (0.6%) was missed with the Generic HIV Viral Load assay. Further, concordantly positive plasma samples harbouring CRF02_AG and CRF06_cpx yielded significantly higher HIV-1 RNA concentrations when tested by Generic HIV Viral Load, as compared to Amplicor v1.5 (mean differences, +0.33 and +0.67 log(10) copies/ml; P=0.0004 and P=0.002, respectively). The Generic HIV Viral Load assay accurately quantified the majority of the non-B HIV-1 subtypes assessed in this study. Due to its low cost (approximately 10 US $/test), this assay performed with open real-time PCR instruments is now used routinely in the Kesho Bora trial and may be recommended in other African settings.

Kesho Bora Study Group.  2010.  Eighteen-month follow-up of HIV-1-infected mothers and their children enrolled in the Kesho Bora study observational cohorts., 2010 Aug. Journal of acquired immune deficiency syndromes (1999). 54(5):533-41. Abstract

To assess the effectiveness and safety of antiretrovirals (ARVs) used for treatment or prophylaxis in a breastfeeding population of HIV-1-infected women (Burkina-Faso, Kenya, South Africa).

2009

Njeru, DG, Mwanda WO, Kitonyi GW, Njagi EC.  2009.  Prevalence of cytomegalovirus antibodies in blood donors at the national blood transfusion centre, nairobi. Abstract

Cytomegalovirus (CMV) infection in susceptible patients is associated with serious morbidity and a high mortality. Transmission of cytomegalovirus infection through blood transfusion is markedly reduced by transfusion of CMV seronegative blood products, or by transfusion of leucodepleted blood products : There is a very high prevalence of cytomegalovirus antibodies among blood donors at the NBTS, with virtually all blood donors having been exposed to the virus. Since the CMV remains latent within leucocytes after infection inspite of the prescence of antibodies in seropositive individuals, leucoreduction of blood products is recommended before transfusion to seronegative susceptible patients. In Kenya, susceptible groups of patients include very low birthweight babies, patients with acquired immune deficiency syndrome (AIDS) due to human immunodeficiency virus infections (HIV) patients, patients on myelosuppressive cancer therapy and recipients of kidney transplants. Further studies are recomended to determine the prevalence of CMV antibodies in these patients in order to establish the magnitude of the demand for CMV safe blood

2008

Otieno, CF, Otieno CF, Omonge EO, AMAYO AA, Njagi E.  2008.  Type 2 diabetes mellitus: clinical and aetiologic types, theraphy and quality of glycaemic control of ambulatory patients. Abstract

Type 2 diabetes is a heterogeneous disease with multiple causes revolving around beta cell dysfunction, insulin resistance and enhanced hepatic glucose output. Clinical judgement based on obesity status, age of onset and the clinical perception of residual beta cell insulin secretory function (hence insulin-requiring or not), has been used to determine therapeutic choices for each patient. Further laboratory testing of the clinically defined type 2 diabetes unmasks the various aetiologic types within the single clinical group. Objective: To determine the aetiological types of the clinically defined type 2 diabetic patients, their chosen therapies at recruitment and the quality of glycaemic control achieved. Design: Descriptive cross-sectional study. Setting: Diabetes out-patient clinic of Kenyatta National Hospital, Nairobi, Kenya. Results: A total of 124 patients with clinical type 2 diabetes were included, 49.2% were males. The mean duration of diabetes in males was 26.09 (20.95) months and that of females was 28.68 (20.54) months. The aetiological grouping revealed the following proportions: Type 1A-3.2%, Type lB-12.1%, LADA-5.7%, and "true" type 2 diabetes 79.0%. All the patients with Type IA were apparently, and rightly so, on "insulin-only" treatment even though they did not achieve optimal glycaemic control with HbAlc % = 9.06. However the study patients who were type IB and LADA were distributed all over the treatment groups where most of them did not achieve optimal glycaemic control, range of HhAc of 8.46 -10.6%. The patients with "true" type 2 were also distributed all over the treatment groups where only subjects on 'diet only' treatment had good HbAlc of 6.72% but those in other treatment groups did not achieve optimal glycaemic control of HbA1c, 8.07 - 9.32%. Conclusion: Type 2 diabetes is a heterogeneous disease where clinical judgement alone does not adequately tell the various aetiological types apart without additional laboratory testing of C-peptide levels and GAD antibody status. This may partly explain the inappropriate treatment choices for the various aetiological types with consequent sub-optimal glycaemic control of those patients.

2003

2001

NJAGI, DRCHOMBAEPHANTUS.  2001.  Kaul R, Rowland-Jones SL, Kimani J, Dong T, Yang HB, Kiama P, Rostron T, Njagi E, Bwayo JJ, MacDonald KS, McMichael AJ, Plummer FA. Late seroconversion in HIV-resistant Nairobi prostitutes despite pre-existing HIV-specific CD8+ responses. J Clin Invest 20. J Clin Invest 2001 Feb;107. : African Wildlife Foundation. Nairobi Abstract
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.
NJAGI, DRCHOMBAEPHANTUS.  2001.  Kaul R, Dong T, Plummer FA, Kimani J, Rostron T, Kiama P, Njagi E, Irungu E, Farah B, Oyugi J, Chakraborty R, MacDonald KS, Bwayo JJ, McMichael A, Rowland-Jones SL.CD8(+) lymphocytes respond to different HIV epitopes in seronegative and infected subjects.. J Clin Invest 2001 May;107(10):1303-10. : African Wildlife Foundation. Nairobi Abstract
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.

2000

NJAGI, DRCHOMBAEPHANTUS.  2000.  Kaul R, Plummer FA, Kimani J, Dong T, Kiama P, Rostron T, Njagi E, MacDonald KS, Bwayo JJ, McMichael AJ, Rowland-Jones SL.HIV-1-specific mucosal CD8+ lymphocyte responses in the cervix of HIV-1-resistant prostitutes in Nairobi. J Immunol 2000 Feb 1;164(3). J Immunol 2000 Feb 1;164(3):1602-11. : African Wildlife Foundation. Nairobi Abstract
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.
NJAGI, DRCHOMBAEPHANTUS.  2000.  MacDonald KS, Fowke KR, Kimani J, Dunand VA, Nagelkerke NJ, Ball TB, Oyugi J, Njagi E, Gaur LK, Brunham RC, Wade J, Luscher MA, Krausa P, Rowland-Jones S, Ngugi E, Bwayo JJ, Plummer FA. Influence of HLA supertypes on susceptibility and resistance to human. J Infect Dis 2000 May;181(5):1581-9. : African Wildlife Foundation. Nairobi Abstract
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.

1999

NJAGI, DRCHOMBAEPHANTUS.  1999.  Fudyk TC, Maclean IW, Simonsen JN, Njagi E, Kimani J, Brunham RC, Plummer FA. Genetic diversity and mosaicism at the por locus of Neisseria gonorrhoeae. J Bacteriol 1999 Sep;181(18):5591-9. J Bacteriol 1999 Sep;181(18):5591-9. : African Wildlife Foundation. Nairobi Abstract
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.

1995

NJAGI, DRCHOMBAEPHANTUS.  1995.  Temmerman M, Nagelkerke N, Bwayo J, Chomba EN, Ndinya-Achola J, Piot P. HIV-1 and immunological changes during pregnancy: a comparison between HIV-1-seropositive and HIV-1-seronegative women in Nairobi, Kenya.AIDS. 1995 Sep;9(9):1057-60.. AIDS. 1995 Sep;9(9):1057-60.. : African Wildlife Foundation. Nairobi Abstract
Department of Obstetrics and Gynaecology, University of Ghent, Belgium. OBJECTIVE: To assess changes in the proportion of CD4 and CD8 T-lymphocyte profiles during pregnancy, at delivery and postpartum, and to determine whether HIV-1 infection affects the normal profile. DESIGN AND METHODS: A total of 416 pregnant HIV-1-infected women and an age and parity-matched HIV-seronegative group of 407 pregnant women were enrolled into a prospective study on the impact of HIV-1 infection on pregnancy. Maternal blood was obtained for lymphocyte subset determination at enrollment, delivery and 6 weeks postpartum. Whole blood sample drawn in EDTA-containing tubes were used to determine T-helper/inducer (CD4) and T-suppressor/cytotoxic (CD8) cells by direct immunofluorescence using monoclonal antibodies. RESULTS: No relationship was found between gestational age and any immunological variable. The CD4 percentage was lower postpartum than antenatally, in both HIV-1-seropositive and seronegative women, but this was not true for absolute CD4 counts. CD8 absolute counts and percentages were significantly higher postpartum than antenatally. The differences between HIV-1-seropositive and seronegative women in changes over pregnancy in CD4 and CD8 cells and their ratio, were not statistically significant. CONCLUSION: Our findings do not support a short-term synergistic effect of HIV-1 and pregnancy on the immune function as determined by T-lymphocyte subsets. PIP: The impact of HIV-1 on pregnancy was investigated in a prospective case-control study of 416 pregnant HIV-infected women and 407 age- and parity-matched pregnant HIV-seronegative women from Nairobi, Kenya. No relationship existed between gestational age (14-30 weeks) and any hematologic or immunologic variable studied. In both cases and controls, the CD4 percentage (but not absolute count) was lower postpartum than during pregnancy, while CD8 absolute counts and percentages were significantly higher in the postpartum period. The differences between HIV-positive and HIV-negative women in changes during pregnancy in CD4 and CD8 cells and their ratio were not statistically significant. These findings fail to provide support for a synergistic effect of HIV-1 and pregnancy on immune function. Further studies are needed, however, to assess the long-term effects of pregnancy in HIV-infected women, to determine the impact of pregnancy at different stages of HIV disease, and to establish normal and HIV-1-related T-lymphocyte subset profiles during the entire course of pregnancy in African women.
NJAGI, DRCHOMBAEPHANTUS.  1995.  Temmerman M, Njagi E, Nagelkerke N, Ndinya-Achola J, Plummer FA, Meheus A. Mass antimicrobial treatment in pregnancy. A randomized, placebo-controlled trial in a population with high rates of sexually transmitted diseases. J Reprod Med 1995 Mar;40(3):176-. J Reprod Med 1995 Mar;40. : African Wildlife Foundation. Nairobi Abstract
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.

1994

NJAGI, DRCHOMBAEPHANTUS.  1994.  Temmerman M, Chomba EN, Ndinya-Achola J, Plummer FA, Coppens M, Piot P. Maternal human immunodeficiency virus-1 infection and pregnancy outcome.Obstet Gynecol. 1994 Apr;83(4):495-501.. Obstet Gynecol. 1994 Apr;83(4):495-501.. : African Wildlife Foundation. Nairobi Abstract

Department of Medical Microbiology, University of Nairobi, Kenya. OBJECTIVE: To study the impact of maternal human immunodeficiency virus type 1 (HIV-1) infection on pregnancy outcome. METHODS: Between January 1989 and December 1991, 406 HIV-1-seropositive and 407 HIV-1-seronegative age- and parity-matched pregnant women from Nairobi, Kenya, all at less than 28 weeks' gestation, were recruited into a prospective study of HIV-1 infection in pregnant women and their offspring. Both groups were followed until 6 weeks postpartum. RESULTS: Three hundred fifteen HIV-1-seropositive women and 311 HIV-1-seronegative controls were followed until delivery. Seropositive women were younger at sexual debut and reported more lifetime partners and more sexually transmitted diseases (STDs) than the seronegative controls. The seropositive women had higher rates of genital ulcer disease (4.7 versus 2.0%; P = .08), genital warts (4.9 versus 2.0%; P = .03), and positive syphilis serology (7.9 versus 3.2%; P < .001), but there were no differences between the groups in isolation rates of Neisseria gonorrhoeae (6.8 versus 7.1%) and Chlamydia trachomatis (11.5 versus 9.0%). Maternal HIV-1 infection was associated with significantly lower birth weight (2913 versus 3072 g; P = .0003) and with prematurity (21.1 versus 9.4%; P < .0001), but not with small for gestational age size (4.2 versus 3.2%; P = .7). The stillbirth rate was higher in seropositive women, yet not statistically significant (3.8 versus 1.9%; P = .2). Women with a CD4 count lower than 30% had a higher risk of preterm delivery (26.3 versus 10.1%; P < .001). Postpartum endometritis was more common in HIV-1-infected women than in seronegative controls (10.3 versus 4.2%; P = .01) and was inversely correlated with the CD4 percentage. No histopathologic placental abnormalities attributable to HIV-1 were detected. CONCLUSION: Maternal HIV-1 infection was significantly associated with prematurity and postpartum endometritis, but not with fetal growth retardation. There was a trend toward a higher stillbirth rate in HIV-1-seropositive mothers.

NJAGI, DRCHOMBAEPHANTUS.  1994.  Detection of human immunodeficiency virus type 1 (HIV-1) in heel prick blood on filter paper from children born to HIV-1-seropositive mothers. J Clin Microbiol. 1994 Nov;32(11):2858-60.. J Clin Microbiol. 1994 Nov;32(11):2858-60.. : African Wildlife Foundation. Nairobi Abstract
Department of Medical Microbiology, University of Nairobi, Kenya. PMID: 7911092 [PubMed - indexed for MEDLINE]
NJAGI, DRCHOMBAEPHANTUS.  1994.  Temmerman M, Chomba EN, Piot P.HIV-1 and reproductive health in Africa. Int J Gynaecol Obstet 1994 Feb;44(2):107-12. Int J Gynaecol Obstet 1994 Feb;44(2):107-12. : African Wildlife Foundation. Nairobi Abstract
Department of Medical Microbiology, University of Nairobi, Kenya. PMID: 7911092 [PubMed - indexed for MEDLINE]
NJAGI, DRCHOMBAEPHANTUS.  1994.  HIV-1 and reproductive health in Africa. Int J Gynaecol Obstet. 1994 Feb;44(2):107-12. Int J Gynaecol Obstet. 1994 Feb;44(2):107-12. : African Wildlife Foundation. Nairobi Abstract

In many African countries where HIV infection is mainly heterosexually transmitted a substantial proportion of women of childbearing age are now infected with the virus. This paper will review the consequences of HIV-1 infection on the reproductive health of seropositive women. The adverse effect of HIV-1 infection on children will be outlined, and strategies for preventing HIV-1 transmission in women of childbearing age and their young children will be discussed

NJAGI, DRCHOMBAEPHANTUS.  1994.  Nyambi PN, Fransen K, De Beenhouwer H, Chomba EN, Temmerman M, Ndinya-Achola JO, Piot P, van der Groen G. Detection of human immunodeficiency virus type 1 (HIV-1) in heel prick blood on filter paper from children born to HIV-1-seropositive mothers. J Clin. J Clin Microbiol 1994 Nov;32(11):2858-60. : African Wildlife Foundation. Nairobi Abstract
Institute of Tropical Medicine, Antwerp, Belgium. The human immunodeficiency virus type 1 (HIV-1) DNA PCR results of 94 dried blood spot (DBS) samples on filter paper and corresponding venous blood in EDTA obtained from infants born to HIV-1-seropositive mothers were compared. In addition, the results of HIV-1 DNA PCR on DBS and the HIV-1 RNA PCR from plasma of 70 paired samples were compared. A 100% specificity and a 95% sensitivity for HIV-1 DNA PCR on DBS compared with results for venous blood were observed for the 94 paired samples. The results of the DBS HIV-1 DNA PCR and HIV-1 RNA PCR of 70 corresponding plasma samples correlated perfectly (100%). The DBS HIV-1 DNA PCR method proved reliable for HIV-1 detection.

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