Combination Of HIV Infection Research Articles

The problem of comorbidity in patients with HIV infection and hepatic cirrhosis in the intensive care unit

Objective: clinical and laboratory assessment of HIV-infected patients in the intensive care unit with liver cirrhosis that developed as a result of hepatitis of various etiologies.Materials and methods: a retrospective assessment of 91 medical records of patients with hepatic cirrhosis among 494 HIV-infected patients in the intensive care unit (ICU) was carried out in order to describe the clinical and laboratory features of the course of liver pathology against the background of HIV infection with secondary diseases. The subjects under observation were 46 (50.5%) men, 45 (49.5%) women, median age — 41 years.Results: patients were diagnosed with profound immunodeficiency (CD4+ lymphocyte count 100,000 copies of HIV RNA per 1 ml — in 45.1% of patients). Child-Pugh class C hepatic cirrhosis was diagnosed in 72.5% of patients. Cirrhosis in most cases developed as a result of toxic hepatitis in combination with chronic hepatitis C (CHC). More than half of the patients showed clinical and laboratory signs of decompensated hepatic cirrhosis. Combinations of two to five secondary infections were diagnosed in 52.8% of patients. The structure of secondary diseases was dominated by bacterial pneumonia, encephalitis and visceral candidiasis. 75.8% of patients did not receive ART, all patients did not receive antiviral therapy for chronic hepatitis.Conclusion: the mortality rate of patients with decompensated liver cirrhosis in the intensive care unit was 80.2% and was associated with the number of secondary diseases and the lack of antiretroviral therapy. Patients with a combination of HIV infection and viral hepatitis require earlier diagnosis and prescription of etiotropic therapy.

Labor in women with the new coronavirus infection (COVID-19) and HIV infection

BACKGROUND:HIV and COVID-19 remain some of global health problems today. Complications of these diseases, pregnancy and labor, as well as the perinatal condition of newborns can make a significant contribution to the deterioration of the demographic situation in this country. Summarizing the foreign and domestic literature, one may assess the impact of each individual pathogen on the condition of the pregnant woman and the fetus. However, we have not found data on the associative or antagonistic form of symbiosis of these pathogens, as well as on the joint effect on the pregnancy, labor and the condition of newborns in the available literature.
 AIM:The aim of this work was to analyze the outcomes of labor in women with the new coronavirus infection (COVID-19) and HIV infection.
 MATERIALS AND METHODS:We performed a retrospective analysis of birth histories of 63 women who were delivered in S.P. Botkin Clinical Infectious Diseases Hospital (Saint Petersburg, Russia) in the period from April 2020 to March 2022. Of these, 26 birth histories are of women with a combination of HIV infection and COVID-19, and 37 birth histories of women with HIV infection alone. We assessed the severity of COVID-19 in pregnant women with HIV infection, the course of labor, complications during childbirth and the condition of newborns.
 RESULTS:The groups did not differ in the duration of labor, the frequency of labor abnormalities, the volume of blood loss during delivery, the frequency of postpartum complications and the condition of newborns after one and five minutes on the Apgar scale. The duration of the anhydrous interval was significantly longer in women with HIV infection who did not suffer from COVID-19. The frequency of cesarean section was significantly higher in pregnant women with HIV infection and COVID-19. According to pathological examination, inflammatory changes in the placenta and signs characteristic of viral infection occurred more often in the group of women with HIV infection and COVID-19.
 CONCLUSIONS:The presence of COVID-19 affects the course of labor in patients with HIV infection. However, the frequency of caesarean section in the group of patients with HIV infection and COVID-19 was significantly higher due to obstetric reasons, and was not related to the severity of the mothers condition and the prenatal state of the fetus due to the infectious process. Inflammatory changes in the placenta and signs of a viral infection are more common in patients with COVID-19 and HIV infection. These data suggest that the combined course of these diseases may have a greater negative impact on the fetus than in women with HIV infection who do not suffer from COVID-19.

Distribution of CD68 and CD3 immune cells in the cervix of women with infectious and non-infectious immunodeficiency

Women with immunodeficiency conditions are a separate cohort of patients who need the close attention of doctors and social workers. The aim of the study was to determine the distribution of CD68 and CD3 immune cells in the cervix of women with infectious and non-infectious immunodeficiency, namely, HIV infection, chronic alcoholism and their combination. Research groups were formed based on the results of autopsies of 100 women of reproductive age, 25 cases in each group: a group with HIV infection, a group with chronic alcoholism, a group with a combination of HIV infection and alcoholism, and a comparison group. An immunohistochemical study was performed with monoclonal antibodies to CD68 and CD3. During the research it was established that the CD68 and CD3 immune cells distribution in the cervix of women with infectious and non-infectious immunodeficiency is characterized by a decrease in CD68 in the epithelial layer of both groups of HIV-infected women (up to (1.06±0.13) cells/mm2 for the group without alcoholism and up to (1.09±0.11) cells/mm2 in the group in combination with alcoholism), while in the group of women who abuse alcohol, this indicator increased to (1.96±0.15) cells/mm2 (p<0.05). In the stroma, the accumulation of CD68-positive cells tends to decrease in all groups. The dynamics of the distribution of CD3-positive cells in different zones of the cervix is characterized by their decrease in the epithelium of HIV-infected groups, while in women who abuse alcohol their number is increased (p<0.05) to (3.86±0.14) cells/mm2. Simultaneously, stroma infiltration of all three groups with HIV is characterized by a significant increase in CD3-positive cells to (8.13±0.79), (9.89±0.57) and (9.04±0.75) cells/mm2 for groups with HIV infection, abuse alcohol and the combination of chronic alcoholism and HIV infection, respectively (p<0.05). Based on the results of the study, it can be concluded that the CD68 and CD3 immune cells distribution in the cervix of women with infectious and non-infectious immunodeficiency is characterized by variability depending on the nature of the immunodeficiency. Keywords: cervical mucosa, immune response, HIV-infection, alcoholism, lymphocytes.

Triple-negative transformation of the endometrium, cervix and mammary gland on the background of immunodeficiency

Precancerous processes of the female reproductive system continue to be an issue that is being actively studied, despite the successes of recent years. One of the key prognostic factors is the characterization of the receptor set, primarily the mammary gland and endometrium, namely estrogen (ER), progesterone (PR), epidermal growth factor-2 (HER2) receptors. Purpose – to identify the features of the distribution of estrogen, progesterone and epidermal growth factor receptors in the tissues of the endometrium, cervix and mammary gland with a combination of HIV infection and alcohol abuse. Fifty women of reproductive age from 20 to 40 years were studied. After routine conduction and immunohistochemical staining, ER and PR expression were determined by a modified D.Allred scale. HER2 expression was determined by a semi-quantitative method. The obtained digital data were statistically processed. A morphometric study indicates that the combination of HIV infection and alcohol abuse significantly affects the distribution of receptors in the female reproductive system. To a greater extent, the overall score is reduced by reducing the number of cellular elements with the expression of ER and PR. HER2 receptor expression is significantly reduced in the endometrium and mammary gland. These changes may be facilitated by atrophic changes in these organs, which occurs in immunodeficiency. According to the D.Allred scale, the mean score decreases from 5.45±0.63 to 3.10±0.88 in the endometrium, from 4.68±0.65 to 2.47±0.58 in the cervix, from 6.57±0.67 to 3.57±0.77 in the mammary gland (p<0.05). HER2 expression decreased from 3.24±0.47 to 2.21±0.23 in the endometrium, from 3.43±0.66 to 2.36±0.32 in the mammary gland (p<0.05). The development of immunodeficiency is characterized by the restructuring of female reproductive organs with a change in the receptor set of the endometrium, cervix and mammary gland and a decrease in both the qualitative and quantitative composition of the receptors, which may serve as a prerequisite for the development of a triple-negative phenomenon in tumors of these organs.

Sociodemographic, clinical and epidemiological characteristics of the men with HIV infection and syphilis in St. Petersburg

The purpose statement is to analyze the socio-demographic, clinical, epidemiological, and behavioral characteristics of patients with only HIV infection and those co-infected with HIV and Tr. pallidum, which are under supervision in St. Petersburg GBUZ «Center for the Prevention and Control of AIDS and Infectious Diseases».Material and methods. The data of outpatient cards of 588 patients who were registered in the dispensary at the St. Petersburg Central Clinical Center in the period from 2018 to 2020 were studied, and the data of the cards of males (435 people) were selected. Patients were divided into two groups: with HIV monoinfection (198 people) and with a combination of HIV infection and syphilis (237 people).Results. Patients co-infected compared with HIV-only patients were less likely to have higher education, were less likely to be married, were diagnosed with HIV infection more often at self-report and during routine examination, there were more men who hade sex with men (homosexual), and bisexual men. Co-infected patients were less likely to have used drugs in the present or in the past and were primarily infected with HIV through sexual contact. They were diagnosed mainly with early forms of syphilis. In patients with coinfection, concomitant diseases of the kidneys, cardiovascular, endocrine systems were often detected, and a high comorbidity with chronic hepatitis B was also noted.Conclusion. The identified socio-demographic, clinical, epidemiological and behavioral characteristics of men with HIV + syphilis coinfection indicate the need for more active work aimed at popularizing barrier contraception among men, especially MSM and prone to bisexual contacts; when syphilis is detected in HIV-infected patients, conduct a thorough examination of all organs and systems, extraordinary for the presence of viral hepatitis.

Lyell´s syndrome provoked by external drug use

Lyells syndrome is rare. Up to 10 cases are registered per million population per year. The mortality rate for Lyells syndrome is 512%.
 Two patients were observed aged, respectively, 38 years and 72 years with Lyells syndrome. The disease manifested itself against the background of local application of drugs. In one case ― Dolobens gel as an analgesic at the site of a bruise of the right hand. In another case, a 20% solution of chlorohxidin biogluconate as a mouth rinse for stomatitis. The first symptoms of the disease occurred locally at the site of application of these medicines. In the first case, the skin of the right hand, in the second ― the mucous membrane of the mouth. The outcome of the disease depended on early diagnosis, urgent hospitalization in a specialized department, from the area of skin lesions, the appointment of adequate therapy.
 Lyells syndrome can occur at any age, and the risk of developing the disease increases in those over the age of 40. In the elderly, SL in terms of the first symptoms and rate of disease progression, the nature of skin and mucous membrane lesions does not have any fundamental differences with those in younger patients. The distinctive features and risk factors of Lyells syndrome in the elderly include, firstly, its occurrence against the background of the already formed comorbid age-related pathology of internal organs, secondly, the concomitant age-related pathology during the development of an acute toxic-allergic reaction is decompensated, a multiorgan failure is formed, which is the cause of more severe Lyells syndrome and higher mortality. In young people, a comorbid viral infection can be considered a risk factor, especially the combination of HIV-infection and chronic hepatitis C.

Genitourinary tuberculosis in the structure of autopsy morphological findings in deceased patients at the late stages of HIV infection

Introduction. The problem of tuberculosis (TB) has not lost its significance due to the overlapping epidemic of HIV infection and the addition of specific lesions at its late stages. It is due to the lack of adherence to antiretroviral therapy in a large number of patients. The high mortality rate in HIV-associated TB requires an increase in the interest of all doctors for the early detection of various TB localizations against the background of HIV, allowing the patient to be cured. For urologists, information on the frequency of genitourinary TB in HIV patients is of interest to improve its diagnosis. Purpose of the study. To identify the proportion of genitourinary TB in the structure of the specific lesions in patients with HIV-associated TB. Materials and methods. The case-records of 115 deceased patients with a combination of HIV infection and TB were retrospectively analyzed using a continuous method. The number of men among them was 81.7 ± 3.6% (94). The average age of men was 37.1 ± 27.2 years, women — 31.9 ± 6.3 years. The research results were processed statistically. Results. The average period from the moment of HIV infection detection to the registration of a lethal outcome was 2.8 ± 1.3 years, from the moment of TB diagnosis — 6.96 ± 7.3 years. The majority of patients with HIV infection had a stage of secondary diseases (93.1 ± 2.4%). At the time of admission to the TB dispensary, the average CD4 + lymphocyte level was 131.06 ± 75.8 cells/pL, 10.03 ± 2.5%. Anti-retroviral therapy was observed only in 19 (16.5 ± 3.5%) patients. In deceased patients disseminated pulmonary TB was more often verified at autopsy — 52.2 ± 4.7%, miliary — 7.8 ± 2.5%, infiltrative — 11.3 ± 3.0%. In patients with disseminated and miliary pulmonary TB, foci of dropout were often observed in the spleen (71.7 ± 5.8% and 55.6 ± 16.6%) and liver (46.7 ± 6.4% and 33.3 ± 15,7%). The kidney damage occurred in 60.0 ± 6.3% of patients with disseminated and 44.4 ± 16.6% miliary pulmonary TB. Kidneys TB was confirmed by bacterioscopic urine examination in three cases only (2.6 ± 1.5%) during life. Prostate TB was confirmed by analysis of expressed prostatic secretion on Mycobacterium tuberculosis (2.6 ± 1.5%) and was combined with kidney TB. The lesions of the lymphatic system during life were exposed in 17.4 ± 3.5% of patients. A pathomorphological examination revealed TB of intrathoracic lymph nodes in 37.4 ± 4.5%, intra-abdominal lymph nodes — in 22.6 ± 3.9%, peripheral — 6.1 ± 2.2%, more often in miliary and disseminated pulmonary TB. TB meningitis was registered in 31 cases as well as meningoencephalitis in 32 patients during life and at autopsy, respectively. Intestinal TB was confirmed by autopsy in 9.6 ± 2.7% of patients; during life, it was accompanied by the detection of the pathogen in the feces. The pancreatic TB was detected in 2.6 ± 1.5%, TB spondylodiscitis in 1.7 ± 1.2%, myocardial TB in 0.9 ± 0.9% and pericardium TB in 0.9 ± 0.9% cases. Conclusion. Thus, generalized TB is diagnosed in patients in the late stages of HIV infection, in the structure of which kidney damage is in second place, yielded only to spleen damage. Obtaining this information should form the alertness of urologists in terms of detecting and diagnosing genitourinary TB in patients with HIV infection.

THE COURSE OF A COMBINATION OF HIV INFECTION, TUBERCULOSIS, KAPOSI'S SARCOMA IN A PATIENT WHO ARRIVED FROM THE PENITENTIARY SYSTEM (CLINICAL CASE)

The article discusses the problems of polymorbidity in HIV infection, the causes of the unfavorable course of combined diseases, and the influence of social factors on the outcome of diseases. An epidemic variant of Kaposi's sarcoma develops against the background of immunosuppression and is a clinical marker of AIDS. In the first years of the pandemic, it occurred in every third patient and was one of the most common AIDS indicator diseases. In recent years of the HIV and AIDS epidemic, the incidence of Kaposi's sarcoma has decreased by more than 10 times. The course of HIV-associated Kaposi's sarcoma can vary, from long-term stable, lasting for years, to progressive, leading to the patient's death in a few months. The introduction of ARV therapy into practice has also changed the clinical course of Kaposi's sarcoma, its forms with aggressive malignant course are now rare. However, they do occur. A clinical case of a combination of HIV infection, tuberculosis, Kaposi's sarcoma in a patient who arrived from the penitentiary system is presented. It is emphasized that social status and social maladaptation, including stay in prison, has a significant impact on the outcome of combined pathology, along with other aggravating factors. In a patient who has previously had tuberculosis, from the moment of HIV detection to the manifestation of Kaposi's sarcoma, 4 years passed, from the appearance of the first signs of Kaposi's sarcoma to the fatal outcome – 4 months. The clinical case demonstrates the difficulties of differential diagnosis of disseminated pulmonary tuberculosis with Kaposi's sarcoma in a patient with severe immunodeficiency due to HIV; and reflects the influence of social factors on the rapidly progressive course of the combined pathology.

The study of life quality parameters in children and adolescents with HIV associated tuberculosis

The objective of the study:to perform comparative assessment of life quality (LQ) associated with health of children and adolescents suffering from tuberculosis, both HIV negative and HIV positive.Subjects and methods. In 2017-2019, the cross-sectional epidemiological study was conducted in Pediatric Department of Samarkand Regional TB Dispensary, the study was aimed to assess life quality associated with health in 70 children and adolescents at the age from 5 to 18 years old. 35 of them had tuberculosis and HIV infection (TB/HIV Group), 35 had tuberculosis and negative HIV status. Pediatric Quality of Life Inventory – PedsQL was used to assess the life quality.Conclusion. The combination of HIV infection and tuberculosis has a more pronounced effect on the physical and mental functioning of patients and worsens the life quality of children and adolescents to a greater extent than tuberculosis.

Upregulation of Chitinase 1 in Alveolar Macrophages of HIV-Infected Smokers.

Recent studies suggest that HIV infection is an independent risk factor for the development of chronic obstructive pulmonary disease (COPD). We hypothesized that HIV infection and cigarette smoking synergize to alter the function of alveolar macrophages (AMs). To test this hypothesis, global transcriptome analysis was performed on purified AMs from 20 individuals split evenly between HIV-uninfected nonsmokers and smokers and untreated HIV-infected nonsmokers and smokers. Differential expression analysis identified 143 genes significantly altered by the combination of HIV infection and smoking. Of the differentially expressed genes, chitinase 1 (CHIT1) and cytochrome P450 family 1 subfamily B member 1 (CYP1B1), both previously associated with COPD, were among the most upregulated genes (5- and 26-fold, respectively) in the untreated HIV-infected smoker cohort compared with HIV-uninfected nonsmokers. Expression of CHIT1 and CYP1B1 correlated with the expression of genes involved in extracellular matrix organization, oxidative stress, immune response, and cell death. Using time-of-flight mass cytometry to characterize AMs, a significantly decreased expression of CD163, an M2 marker, was seen in HIV-infected subjects, and CD163 inversely correlated with CYP1B1 expression in AMs. CHIT1 protein levels were significantly upregulated in bronchoalveolar lavage fluid from HIV-infected smokers, and increased CHIT1 levels negatively correlated with lung function measurements. Overall, these findings raise the possibility that elevated CHIT1 and CYP1B1 are early indicators of COPD development in HIV-infected smokers that may serve as biomarkers for determining this risk.

TREATMENT OF PATIENTS AGAINST THE PULMONARY INVOLVEMENT IN THE CONDITIONS OF COMORBIDITY AT LATE DETECTION OF HIV INFECTION AND WITHOUT ART

Early diagnosis and effective treatment, including operative, in patients with comorbide conditions of pulmonary involvement affected by HIV infection with various infection ways is relevant. Materials and methods. Two clinical cases with pulmonary involvement in comorbidity conditions with the late detection of HIV infection and without antiretroviral therapy are presented. Results. It has been shown that a reduction in the high incidence of adverse outcomes of severe comorbid forms of the disease (in particular, a combination of HIV infection and tuberculosis) can be achieved by conducting an adequate monitoring of these patients, including secondary chemoprophylaxis of tuberculosis as well as, detection, treatment and prevention of co-infections and timely elimination of other possible risk factors (both social and medical). Conclusion. It is necessary to develop optimal algorithms and approaches of medical and psychosocial impact, focused on the initial period of treatment of patients with HIV infection (antiretroviral therapy, anti-tuberculosis therapy, prevention of opportunistic infections, etc.), since it is during this period that the greatest number of severe cases of the disease and adverse outcomes are observed.

ИССЛЕДОВАНИЕ КАЧЕСТВА ЖИЗНИ ВИЧ-ИНФИЦИРОВАННЫХ БОЛЬНЫХ С ЗАБОЛЕВАНИЯМИ ОРГАНА ЗРЕНИЯ

The importance and the need to establish standards for the quality of life for HIV-infected patients with eye diseases were proved. The scheme of follow-up of ophthalmic patients with HIV infection was created; it allows identifying the relationship between the organ of vision and quality of life of infected patients. An algorithm of examination of patients with a combination of HIV infection and ophthalmological pathology was developed. It is proved that with the growth of the severity of internal organ involvement in HIV-infected patients a decrease in quality of life occurs pro rata, par-ticularly in patients in 3–4th stages of HIV infection associated with atrophy of the optic nerve, uveitis, retinitis. It was established that on the background of an effective anti-viral and vascular therapy of HIV-infected patients there is a positive dynamics of vision in patients with retinal angiopathies.

A deadly combination - HIV and diabetes mellitus: Where are we now?

The combination of HIV infection and diabetes mellitus (DM) represents a collision of two chronic conditions. Both HIV and DM increase the risk of developing tuberculosis (TB). Health resources in developing countries are already under strain as a result of the TB epidemic and poor diabetic control would further worsen this epidemic. Optimal diabetic control provides one avenue of curbing the TB epidemic in developing countries. To establish if there is a difference in blood pressure, lipid and glycaemic control and complications between HIV-infected and uninfected diabetic patients; and to compare characteristics among HIV-infected diabetic patients between those with optimal and sub- optimal glycaemic control. This was a retrospective chart review of all patients who visited the Edendale Hospital diabetic clinic, Pietermaritzburg, from 1 October 2012 to 30 September 2013. There were statistically significant differences noted in the following parameters between HIV-infected and uninfected diabetic patients: (i) mean HbA1c% (11.08% v. 10.14%, respectively); (ii) nephropathy defined by proteinuria (25.66% v. 15.43%); (iii) neuropathy (48.68% v. 42.10%); and (iv) Kidney Disease Outcomes Quality Initiative (KDOQI) stage ≥2 chronic kidney disease (30.87% v. 41.67%). There were no significant differences noted in the percentage of patients achieving the following target parameters between the two cohorts: (i) blood pressure (42.11% v. 35.62%); (ii) total cholesterol (36.84% v. 34.67%); and (iii) triglycerides (42.76% v. 40.19%). Within the HIV-infected diabetic cohort 85.23% displayed suboptimal glycaemic control. A significant percentage of HIV-infected diabetic patients on antiretroviral (ARV) therapy (89.36%) had suboptimal glycaemic control. HIV-infected female diabetic patients showed a significant increased waist circumference when compared with their HIV-uninfected counterparts. HIV-infected diabetic patients had significantly poorer blood sugar control and a higher incidence of neuropathy and nephropathy (when defined by overt proteinuria). There was a non-significant difference noted between the HIV-infected and uninfected diabetic patients with regard to blood pressure and lipid control. The majority of HIV-infected patients on ARVs failed to achieve target glycaemic control. Obesity remains a global challenge, as noted in both the HIV-infected and uninfected diabetic patients.

Genetic predictor of working memory and prefrontal function in women with HIV.

The Val158Met (rs4680) single-nucleotide polymorphism (SNP) of the catechol-O-methyltransferase gene (COMT) influences executive function and prefrontal function through its effect on dopamine (DA) metabolism. Both HIV and the Val allele of the Val158Met SNP are associated with compromised executive function and inefficient prefrontal function. The present study used behavioral and neuroimaging techniques to determine independent and interactive associations between HIV serostatus and COMT genotype on working memory and prefrontal function in women. For the behavioral study, 54 HIV-infected and 33 HIV-uninfected women completed the 0-, 1-, and 2-back conditions of the verbal N-back, a working memory test. For the imaging study, 36 women (23 HIV-infected, 13 HIV-uninfected) underwent functional magnetic resonance imaging (fMRI) assessments while completing the N-back task. HIV-infected women demonstrated significantly worse N-back performance compared with HIV-uninfected women (p < 0.05). A significant serostatus by genotype interaction (p < 0.01) revealed that, among Val/Val, but not Met allele carriers, HIV-infected women performed significantly worse than HIV-uninfected controls across N-back conditions (p < 0.01). Analogous to behavioral findings, a serostatus by genotype interaction revealed that HIV-infected Val/Val carriers showed significantly greater prefrontal activation compared with HIV-uninfected Val/Val carriers (p < 0.01). Conversely, HIV-uninfected Met allele carriers demonstrated significantly greater prefrontal activation compared with HIV-infected Met allele carriers. Findings suggest that the combination of HIV infection and the Val/Val COMT genotype leads to working memory deficits and altered prefrontal function in HIV-infected individuals.

HIV, infant feeding, and survival: old wine in new bottles, but brimming with promise

A string of new studies most of which have been presented at international meetings and are as yet unpublished have resulted in a gathering momentum of interest in HIV and infant feeding. In rich and some middle-income countries transmission of HIV antenatally and during labour and delivery has been substantially reduced by antiretrovirals and other interventions. Postnatal transmission was prevented by advising against breastfeeding; the alternative was replacement feeding with formula milks as these could be safely prepared were affordable and were culturally acceptable. The discourse on formula feeding or breastfeeding by HIV-positive mothers in developing countries has been mired in confusion or locked in robust disagreement. WHO/UNICEF/UNAIDS guidelines offered a framework for making choices based on socioeconomic conditions and household capability to prepare formula hygienically. The difficulty in the field was to offer an optimum balance of choices between the two types of milk feeding. Exclusive breastfeeding for 6 months is the recommendation for those choosing breastfeeding. Recent data from ongoing and completed studies in Africa have suggested that the effects of avoidance of breastfeeding or cessation even at 6 months by HIV-positive mothers can be disastrous. This finding repeats what has been and remains the bedrock of public health policy for infants and children well before the HIV epidemic and recognized through centuries of human experience. The new findings have led to the WHO refining its Guidelines on HIV and Infant Feeding in late 2006. (excerpt)