Friday, June 24, 2016

WHO confirms antiretroviral therapy reduces the risk of life-threatening HIV-related infections

20 June 2016 - Adults and children with HIV who start antiretroviral therapy (ART) as early as possible reduce their risk of developing serious HIV-related infections, according to new findings published in the journal Clinical Infectious Diseases on 15 June 2016.
Woman standing at the door, smiling
WHO/A. Kari
Two studies in adults and children, supported by the World Health Organization (WHO) and conducted in collaboration with Columbia University, the London School of Hygiene & Tropical Medicine and McGill University, are the first global systematic and comprehensive analyses of data on HIV-related opportunistic infections over a 20-year period in 3 global regions: Africa, Asia and Latin America. The 2 reviews compared the risk of serious HIV-related infections before and after starting ART, then estimated the global number of cases of infection that would have been prevented (using data from 2013), and the costs saved, if ART had been started earlier.
“Opportunistic and other infections are the major cause of death in adults and children with HIV,” said Dr Philippa Easterbrook from WHO’s Department of HIV. “There have been previous estimates on the impact of ART in reducing deaths and new HIV infections, but not on its impact on each of the serious infections to which people with HIV are vulnerable, especially in low-income settings. Knowing how common these infections are is really important for planning HIV health services in these countries, including procuring drugs and diagnostic tests.”
In 126 different studies based on almost half a million adult HIV patients, the most common infections were oral thrush, tuberculosis, shingles and bacterial pneumonia – each of which occurred in more than 5% of adults before ART. There was a major reduction in the risk of development of all infections for those on ART, by 57% to 91%, and this was greatest in the first year of treatment. It was estimated that earlier ART would have prevented at least 900 000 cases of life-threatening infections and saved around US$ 50 million in 2013.
In the second review – 88 studies based on 55 679 HIV-infected children – bacterial pneumonia and tuberculosis were the most common infections, each occurring in around 25% of children before ART. As with the adult studies, there was a reduction in risk for all infections for those on ART, but this was greatest (by more than 80%) for HIV-related diarrhoea, cerebral toxoplasmosis and tuberculosis, with a smaller impact on bacterial septicemia and pneumonia. It was estimated that earlier access to ART could have prevented at least 161 000 cases of serious infections in children, with a saving of around US$ 17 million in 2013.
“Compared to adults, there is always a relative lack of data on HIV-infected children to inform guidelines and practice, and the scale-up of ART in children has been much less successful,” said coauthor Dr Marie-RenĂ©e B-Lajoie from McGill University. “But our study shows that the effect of ART in reducing HIV-related infections in children is as dramatic as that seen in adults.”
Dr Andrea Low, coauthor from ICAP, Columbia University, commented that “the level of effect of ART on serious infections in adults in these low-income settings was even more striking than that observed in high-income countries”. However, she also noted that interpretation of regional variation in incidence and the effect of ART is limited, as there were significant gaps in data from some regions, such as Latin America.
Dr Gottfried Hirnschall, Director of WHO’s HIV Department, concluded: “We know that ART has a dramatic effect in reducing death rates as well as new HIV infections. These findings demonstrate that ART has the same effect in reducing the risk of serious HIV-relatedI nfections in adults and children – thus, further explaining the reduction in death rates. This reinforces the need to continually prioritize the expansion of access to ART. The new WHO guidelines recommend starting ART in all HIV-infected persons as soon as possible, regardless of the stage of infection.”

From the WHO Website

Habari (Hello) from the Motherland!

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A few months ago we introduced two Queen Elizabeth Scholars who are now in Tanzania for the summer. Matt Jalink (Intern) and Keisha Jefferies (Scholar) have sent us updates to share.

Habari (Hello) from the Motherland!

Keisha Jefferies is a Master’s of Nursing student at Dalhousie University
What an experience this has been thus far. Not only is this my first time in Tanzania, but it is also my first trip to the Motherland. I was unsure of what to expect in terms of the lifestyle, social norms and attitudes, but I am definitely adjusting, settling in nicely and loving every moment!
Since arriving in Dar, I have been learning Swahili (one of the National languages in Tanzania) and it is paying off in the sense that I am able to connect with many people and build relationships. I still have a long way to go before I can hold a decent conversation in Swahili, but people are certainly amused and supportive of my attempts!
Swahili Dar Language (SDL) School where I am learning Swahili.
Swahili Dar Language (SDL) School where I am learning Swahili.

I have also had the opportunity to volunteer with my host (who is a dietician, nutritionist and lifestyle coach) on a project currently underway with the World Food Program (WFP). The project is focused around increasing awareness about healthy living for staff by proving education on healthy food choices, baseline measurements such as blood pressure (BP), fast blood glucose (FBG), height, weight and body mass index (BMI) as well as sharing options for exercise/ physical activity. We had a few busy days of preparing, presenting, taking baseline measurements and interacting with the WFP staff. Currently, my host is completing the analysis and will soon roll out the intervention phase of the project.
WFP Staff/ project coordinators, Nurses from Muhimbili National Hospital (MNH), my host and volunteers.
WFP Staff/ project coordinators, Nurses from Muhimbili National Hospital (MNH), my host and volunteers.

In addition to learning Swahili and volunteering with the WFP project, I am also working on my own project and program requirements for my Masters! Needless to say, it has been a busy 6 weeks but I am finding time to make friends and enjoy the beautiful city of Dar es Salaam. I have met some wonderfully nice people throughout the city and at the university. I have been fortunate enough to have been invited to attend 3 Masters level lectures on Research Methods for the Midwifery and Critical Care students. This was an amazing experience. Not only I was also able to share ideas and learn from the students and faculty, I was able to sit in and provide feedback on thesis topic presentations.
Students from the Masters of Midwifery and Women’s Health program at Muhimbili University of Health and Allied Sciences (MUHAS) and myself enjoying the warm waters of the Indian Ocean.
Students from the Masters of Midwifery and Women’s Health program at Muhimbili University of Health and Allied Sciences (MUHAS) and myself enjoying the warm waters of the Indian Ocean.

Masters students and myself at Kipepeo Beach in Kigamboni.
Masters students and myself at Kipepeo Beach in Kigamboni.

I am looking forward to the many adventures, experiences and opportunities over the next 7 weeks!

Karibu Tanzania! (Welcome to Tanzania)

Matt Jalink is a Community Health and Epidemiology student at Dalhousie University
Karibu Tanzania! (Welcome to Tanzania). I’ve heard this phrase countless times since arriving in Dar es Salaam. Reminiscent of my last visit to the northern city Moshi, the friendliness Tanzanians have shown me is amazing. This hot, bustling metropolis is quickly becoming one of my favorite cities, and stretches out into dozens of districts each with its own subsection of wards. I reside in the city centre district in a quaint little hotel 10 minutes walk from the Indian Ocean. I catch the dala dala (minivan buses) to work every morning in a nearby district called Temeke. Commuting is an experience in itself with obscene driving, constant usage of the horn and doubling the van’s capacity limit giving the suspension a workout. Traffic jams are frequent, so at times hoping on a boda boda (motor cycle taxi) is needed to maneuver around the traffic.
Working as an epidemiology student at PASADA has been a fantastic learning experience. In a very self-directed role, I have been acting primarily as a consultant on a tuberculosis diagnostic test project. Applying the skills I have gained from my coursework to the workplace has been both rewarding and challenging. Participating in data collection in some of the slums of Dar es Salaam was an eye-opening experience despite thinking that I was mentally prepared. However most of my time has been spent assembling the data set and coding the dataset for analysis.
Pastoral Activities and Services for people with AIDS Dar es Salaam Archdiocese (PASADA).
Pastoral Activities and Services for people with AIDS Dar es Salaam Archdiocese (PASADA).

The majority of my free time has been spent exploring the city and surrounding area. Bongoyo Island was a beautiful escape from the city. Watching the Africa Cup of Nations qualifying match between Tanzania and Egypt at the national stadium as an avid football (soccer) player and fan was an incredible atmosphere to be apart of.
Kwaheri! (Bye for now)
The Canadian Queen Elizabeth II Diamond Jubilee Scholarship Program (QES) aims to build a dynamic community of young global leaders in Canada and across the Commonwealth. Queen Elizabeth Scholars engage in projects both at home and abroad, encompassing international education, discovery and inquiry, and professional experiences. Queen Elizabeth Scholars undertake projects that provide meaningful learning experiences, with the potential to create lasting impact. Dalhousie University has teamed up with its partners in the Caribbean, Uganda and Tanzania to develop an international student mobility project, funded by QES, for current Dalhousie students and students in other Commonwealth countries looking to study at Dal. The Global Health Office manages the relationship between our partner associations and Dalhousie, collaborating with many units across campus, and within the QES network, to make these projects possible

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