Infections In South Africa Research Articles

The HIV‐1 epidemic in South Africa

The first reported cases of HIV-1 infection in South Africa occurred in 1982. Two distinct HIV-1 epidemic patterns were recognized. Initially the infection was prevalent in white males who had sex with males. The HIV-1 clade B was associated with this group. By 1989, the second epidemic was recognized primarily in the black population. Infections in this case were mainly heterosexual in origin. The HIV-1 clade involved was mainly C. The national HIV-1 sero-prevalence in antenatal attendees was less than 1% in 1990 and by 1994 this figure had risen to 7.5%. The most recent antenatal surveillance for HIV-1 sero-prevalence in 1999 revealed the following. The national prevalence rate for 1999 was 22.4% compared with the 1998 rate of 22.8%. The data highlighted the profound effect the epidemic had and will have on the disease burden in South Africa and by extension on the social and economic fronts. This view was emphasised by the impact HIV-1 infection had on tuberculosis. For example, sentinel surveys have attributed 44% of tuberculosis cases to HIV-1 infection. Moreover, the high prevalence of sexually transmitted infections will certainly exacerbate the HIV-1 epidemic.

HIV-1 Subtype A, D, G, AG and unclassified sequences identified in South Africa.

HIV-1 subtype C accounts for the vast majority of infections in South Africa. However, increasingly non-C subtypes are being detected. Here we report 10 viruses that contain sequences that group with subtypes A, D, and G as well as CRF02_AG and 1 that could not be classified. Most of these individuals were from other countries in Africa. Some of these sequences were in combination with subtype C, possibly indicating local recombination events. Although there is no indication of endemic spread of these viruses, continued monitoring is warranted to track genetic changes, which may impact on diagnostic testing, therapeutic responses to antiretroviral therapies, and vaccine design.

The evolving HIV epidemic in South Africa.

This paper traces the evolution of the HIV epidemic in South Africa placing it in historical context including an insiders view of the national response to it. It was noted that the first case of HIV infection in South Africa was reported in 1982 which heralded the start of the first wave of HIV epidemic. The epidemic was limited to the gay community blood transfusion recipients and hemophiliacs. However the Apartheid regime in South Africa saw the HIV epidemic as a problem in Blacks or gays that is not seen as a priority deserving of serious attention. Similarly as late as 1989 the progressive anti- Apartheid movement was more concerned with dealing with the immediacy of liberating the country than the possibility of a future AIDS threat. In 1990 Chris Hani chief of the ANC promoted the importance in addressing the AIDS epidemic in the country. Unfortunately before democracy was achieved Hani was tragically assassinated. Since political liberation in 1994 many have commented on what went wrong with the campaign of curbing the epidemic. It was noted that the historic change achieved by liberation forces was not harnessed to confront the epidemic and the prophetic words of Hani went unheeded. Hence it is suggested that the campaign must be continued to bring the epidemic under control.

Denial and defiance: a socio-political analysis of AIDS in South Africa.

Denial and defiance: a socio-political analysis of AIDS in South Africa.

Risky Business: South African youths and HIV/AIDS prevention

Behavior change is the only available means of curtailing new HIV infections in South Africa. This study investigated the relationship between sexual risk taking and attitudes to AIDS precautions. The participants were about 25% white, about 30% colored/mixed blood and 45% black in their second year in polytechnics (413 females and 402 males). Participants responded to the 40-item HIV-related knowledge, attitudes and behaviors. Data indicated that young women showed more positive attitudes to AIDS precautions than young men (reflecting in part the stereotypic negative attitudes of young men toward condoms). In general, most males and females were found to have less knowledge about HIV transmission and less favorable attitudes toward safe sex behavior than their counterparts in the west. Also young men with more partners expressed more fatalistic attitudes toward AIDS. The possibility that a finergrained multivariate analysis of attitudes to AIDS and safe-sex behaviour is something that needs to be taken seriously in future research, however.

Impact of HIV-1 infection in South Africa

In a prospective study, 60% of admissions to an academic hospital were infected with HIV. HIV infected children were younger, less likely to have been referred, more likely to have...

Diagnosis of human immunodeficiency virus infection in perinatally exposed orphaned infants in a resource-poor setting.

Diagnosis of human immunodeficiency virus infection in perinatally exposed orphaned infants in a resource-poor setting.

Relevance of commercial diagnostic tests to detection of enteric adenovirus infections in South Africa.

The prevalence of enteric adenoviruses detected by an in-house enzyme-linked immunosorbent assay (the RIVM-ELISA) ranged from 13 to 38%, and subgroup F adenoviruses comprised 86%. All subgroup F adenoviruses reacted with both RIVM anti-adenovirus type 40 (Ad40) and anti-adenovirus type 41 (Ad41) monoclonal antibodies but were not detected by Adenoclone Type 40/41 enzyme immunoassay (EIA). The correlation between the Biotrin EIA and RIVM-ELISA results was low (26%). Immunospecific tests suggest that a significant proportion of enteric adenoviruses, possibly comprising previously unidentified or emerging types, are not detected by commercial diagnostic tests in South Africa.

The impact of HIV on meningitis as seen at a South African Academic Hospital (1994 to 1998).

The increase in HIV infections in South Africa is alarming. The aim of this prospective 4-year study was to evaluate the rising incidence of HIV-related admissions due to meningitis at the Pretoria Academic Hospital (PAH) adult neurology ward and to investigate the spectrum of meningitis during this time. Adults with meningitis presenting at the PAH neurology ward from March 1994 through February 1998 were included. HIV antibody status was determined and patients were assigned to five categories: bacterial, tuberculous, viral and cryptococcal meningitis, as well as an uncertain category. Over the 4-year study period 141 patients with meningitis were seen. Of these, 44 were HIV-positive (31%), with TB meningitis occurring in 16 (36%), cryptococcal meningitis in 22 (50%) and acute bacterial meningitis in three (7%). In the first 2 years of the study, 14% of patients were HIV positive; this figure rose to 44% in the 3rd year, and 57% in the final year. The spectrum of meningitis also changed: bacterial meningitis remained relatively stable at about 25% of the total; TB meningitis almost doubled from 16% in the 1st year to 31% in the last year of the study; viral meningitis initially occurred in 8% of patients and later in 3% of cases, while cryptococcal meningitis showed the most significant increase from 6% of cases in 1994/5 to 31 and 26% respectively in the last 2 years of the study. Over a 4-year period the HIV epidemic was responsible for a marked shift in the spectrum of meningitis towards chronic infections such as TB and cryptococcal meningitis at the PAH.

Epidemiology of Glycopeptide-Resistant Enterococci Colonizing High-Risk Patients in Hospitals in Johannesburg, Republic of South Africa

Recent cases of infections caused by glycopeptide-resistant enterococci (GRE) have highlighted the emergence of these organisms in the Republic of South Africa. During May 1998 we conducted a prevalence study in four hospitals in Johannesburg and obtained 184 rectal swabs from patients identified as being at high risk for GRE colonization. Twenty enterococcal isolates showing various glycopeptide resistance genotypes were recovered: 3 Enterococcus faecium vanA isolates, 10 E. faecium vanB isolates, 6 E. gallinarum vanC1 isolates, and 1 E. avium vanA isolate. Macrorestriction analysis was used to demonstrate the clonal spread of GRE strains within hospitals. Evidence also demonstrated the likely persistence of the original E. faecium vanA isolate associated with the first confirmed death contributed to by GRE infection in South Africa in March 1997.

New cases of Mokola virus infection in South Africa: a genotypic comparison of Southern African virus isolates.

Mokola virus, one of the six genotypes within the Lyssavirus genus of the Rhabdoviridae family, is believed to be exclusive to the African continent, where infections in various mammal species have been reported. After an isolation of Mokola virus at Umhlanga on the east coast of South Africa in 1970, the virus was not reported in South Africa until its reappearance in 1995. Since then a total of six new isolates of the virus were made, three from the East London region in 1995 and 1996, two near Pinetown in 1997 and a further isolate in a residential suburb of the city of Pietermaritzburg, in 1998. These isolation sites are respectively about 500 km (East London region) and 23 to 60 km from the site of the 1970 isolation Phylogenetically the three isolates from the East London area were similar and could be distinguished from the four KwaZulu-Natal isolates, which formed a defined group of their own. The viruses comprising these two clusters were also found to be distant from another southern African isolate, made in 1982 in Zimbabwe, Mokola virus isolates thus conforms to a pattern of virus evolution strongly influenced by geographical determinants. In comparison to Rabies virus, of which at least two different biotypes are known and a vast array of different wildlife species contribute to its complex epidemiology on the sub-continent, Mokola viruses have only been isolated form one species, i.e. domestic cats, in South Africa. Nevertheless, the heterogeneity among the Mokola virus isolates is far greater than the degree of variation among the Rabies virus populations of the region.

Analysis of the preS1 gene of hepatitis B virus (HBV) to define epidemiologically linked and un-linked infections in South Africa.

Analysis of the preS1 gene of hepatitis B virus was used to define two nosocomial outbreaks of HBV infection. In an outbreak in an oncology unit we had previously shown by single stranded conformational polymorphism (SSCP) analysis of a 189 bp fragment of the preS1 gene, that 52 children were infected with HBV strains that displayed only 5 different SSCP profiles. Sequencing of a 383 bp fragment encompassing the entire preS1 gene, revealed that isolates with same SSCP profile were identical in sequence across the entire preS1 gene, confirming that those patients with the same SSCP pattern had epidemiologically linked infections. A second outbreak involved 8 liver transplant patients from two different hospitals, 5 of whom were from the same hospital at which the oncology outbreak had occurred. Two of these 5 patients had HBV strains that were identical to strains from the oncology unit and nosocomial transmission probably accounted for the infections in these two, while diversity of both SSCP profiles and sequence data of remaining 6 patients supported the conclusion that they had not been infected from a common source. The donor liver is believed to be the most likely source of infection in these patients. HBV isolates from patients infected in the community were used as a standard for the general degree of preS1 sequence variation of local HBV strains. Phylogenetic analysis and comparison with reference HBV clones revealed that of 27 local HBV strains, genotypes A and D occurred most frequently and were identified in 14 and 12 patients respectively, while genotype C was detected in one patient.

Independent epidemics of heterosexual and homosexual HIV infection in South Africa--survival differences.

Survival with HIV infection is shorter in sub-Saharan Africa than in developed countries. The pattern of HIV transmission in our region has changed from homosexual to heterosexual, with viral subtypes similar to those in North America/Europe and Central Africa, respectively. We compared survival for the two transmission patterns after AIDS, and after the first CD4+ lymphocyte counts < 200/microliter and < 50/microliter, for adults presenting 1988-1993. Antiretroviral therapy was excluded. There were 180 homosexuals (63% White, 56% employed) and 314 heterosexuals (67% Black, 34% employed). Extrapulmonary tuberculosis was the AIDS-defining diagnosis in 36/90 heterosexuals and 5/58 homosexuals (p < 0.0001). Survival after AIDS was longer in heterosexuals (p = 0.0015), but AIDS occurred earlier as shown by their higher CD4+ count at AIDS onset (median 98/microliter vs. 40/microliter; p = 0.036). Survival was similar in the two groups after first CD4+ count < 200/microliter and < 50/microliter. Race, socioeconomic status and morbidity are markedly different in the two transmission groups. AIDS occurs with less severe immune suppression in heterosexuals, with correspondingly longer survival. Survival after defined CD4+ counts, however, is remarkably similar.

Incidence of human calicivirus and rotavirus infection in patients with gastroenteritis in South Africa.

Human caliciviruses (HuCVs) are reportedly responsible for 2.5-4% of nonbacterial sporadic gastroenteritis. The incidence of HuCV infection in South Africa is unknown. Stool specimens from 1,296 South African patients with sporadic gastroenteritis were screened for the presence of HuCVs using electron microscopy, recombinant enzyme immunoassays for Norwalk (NV) and Mexican (MX) viruses, and the reverse transcriptase-polymerase chain reaction (RT-PCR). RT-PCR products were sequenced to ascertain which HuCV genogroups were present. HuCVs were detected in 43/1,296 (3.3%) specimens examined, with RT-PCR proving to be the most sensitive detection method. Genetic analysis of the isolates indicated that 81% were Snow Mountain Agent, or MX-like; 8% were NV-like; and 11% were HuCV/Sapporo-like. This study indicates that a combination of assays is needed for the accurate detection of HuCVs. Comparative data on hospitalised patients showed that the incidence of rotavirus infection was approximately ten times greater than that of HuCV infection.

An epidemiological investigation of Norwalk virus infection in South Africa.

A study was carried out to determine the incidence and seroprevalence of Norwalk virus (NV) in the Pretoria area, South Africa, using a recombinant NV (rNV) immunoassay for the detection of serum IgG antibodies. Maternal antibody was detectable in infants' sera up to approximately 6 months of age. Infection with NV was detected serologically in the second year of life and the seroprevalence of NV IgG rose from 37.1% at 7-11 months of age to 62.1% by the age of 40 years. No significant differences in seroprevalence of NV IgG antibody was evident between subjects of European or African ethnic origin, where overall seroprevalence rates were 56.4% and 53.9% respectively.

The current epidemiology of hepatitis A infection in South Africa: implications for vaccination

Testing stored sera from various categories of individuals has shown that among the Black population hepatitis A virus (HAV) infection is universal and most adult Black subjects are immune. Infection probably occurs early in life, consistent with the epidemiological pattern seen in the developing world. By contrast, seroprevalence of HAV infection in adult White subjects increases with age, reflecting an epidemiological pattern seen in the developed world. White subjects working in a virological laboratory and White medical students had comparatively low seroprevalences of HAV infection and could therefore represent groups at risk. Hepatitis A vaccine is likely to be available in South Africa in the near future and could be offered to these groups. Pre-vaccination immunity screening would be a cost-effective strategy.

An evaluation of an education programme on HIV infection using puppetry and street theatre

'Puppets Against AIDS' is a novel educational medium being used to try to reduce the spread of HIV infection in South Africa. It involves the use of street theatre employing two-metre-high puppets who act out a story of how one person, who is infected with HIV, passes it onto a series of other people until he eventually dies. The puppet show was evaluated in two phases. The first involved a content analysis of a video recording of the show by a multidisciplinary group, according to a set of criteria for appropriate education on HIV infection. This show was found to be professional and comprehensive in terms of the educational messages provided. Some suggestions were made for improvements. The second phase was a before and after study of the impact on the audience at a series of live shows. The show made a significant contribution to knowledge and intended behaviour in the short term. Overall it was felt that the show does make a valuable contribution, but could be made more effective if incorporated into existing community-based education programmes on HIV infection.

Household Clustering and Intra-Household Transmission Patterns of Hepatitis B Virus Infection in South Africa

The objective of this study was to investigate household clustering of hepatitis B virus (HBV) infection in South Africa in order to understand intra-household patterns of virus transmission that would provide information on potential risk factors of HBV infection. Subjects were the household contacts of 28 hepatitis B surface antigen (HBsAg) positive children (index-carrier), 22 hepatitis B surface antibody positive children (index-past-infection) and 35 children with no serological evidence of HBV infection (index-negative). Evidence of HBV infection (at least one positive HBV marker) was present in 73.7%, 48.7% and 38.2% and HBsAg was present in 19.9%, 8.7% and 2.9% of household contacts of index-carrier (N = 186), index-past-infection (N = 150) and index-negative (N = 207) children respectively. The clustering of HBV infection and HBsAg was present in all subgroups of household contacts regardless of the degree of relatedness to the index child. As age increased, the cumulative prevalence of HBV infection increased while the likelihood of being HBsAg positive decreased. Regardless of age, males were more likely (p less than 0.01) than females to be HBsAg positive. We conclude that HBV infection clusters in households; that there is an increased susceptibility, which is probably not genetically mediated, of becoming an HBV carrier in certain households and that males are at greater risk of being HBV carriers. Intra-household horizontal person-to-person transmission, the precise mechanisms of which are not known, is important in South African blacks.

HIV and AIDS in South Africa: what is an appropriate public health response?

98 cases of acquired immune deficiency syndrome (AIDS) were reported in the Republic of South Africa by the end of 1987 and 166 my mid-December 1988. By February 12 1990 353 cases of AIDS had been reported--326 in South Africans and 27 in people from either elsewhere in South Africa or abroad. The South African patients comprised 2 main groups white men with the pattern of infection typical of homosexual and bisexual men and heterosexuals exhibiting the pattern common in much of central and southern Africa. There have been a small number of people with hemophilia affected with AIDS but only 1 injecting drug user with AIDS to date. There is evidence of considerable spread of the epidemic into the South African black population. Migrant labor the high prevalence of sexually transmitted diseases and suspicion of government-directed family planning programs have all contributed to this. Seropositivity rates in South African blacks are noted to be rising rapidly and the doubling time is considered to be about 8.5 months. The government and some employers have now adopted discriminatory measures to exercise control over the disease including the screening of migrant workers and the repatriation of those found to be seropositive. Public health leadership from the state authorities has been inappropriate. The authors insist on greater involvement of homosexual worker community and public health personnel in developing policies for control of HIV infection in South Africa if the response is to be ethical nondiscriminatory sensitive prevention-oriented and effective. (authors)

HIV-2 infection in South Africa

Journal Article HIV-2 infection in South Africa Get access Susan F. Lyons, Susan F. Lyons Medical Research Council AIDS Virus Research Unit, Department of Virology, University of the Witwatersrand, National Institute for Virology, Private Bag X4, Sandringham 2131, South Africa Search for other works by this author on: Oxford Academic PubMed Google Scholar Alan N. Smith, Alan N. Smith Medical Research Council AIDS Virus Research Unit, Department of Virology, University of the Witwatersrand, National Institute for Virology, Private Bag X4, Sandringham 2131, South Africa Search for other works by this author on: Oxford Academic PubMed Google Scholar Gillian M. McGillivray, Gillian M. McGillivray Medical Research Council AIDS Virus Research Unit, Department of Virology, University of the Witwatersrand, National Institute for Virology, Private Bag X4, Sandringham 2131, South Africa Search for other works by this author on: Oxford Academic PubMed Google Scholar Barry D. Schoub Barry D. Schoub Medical Research Council AIDS Virus Research Unit, Department of Virology, University of the Witwatersrand, National Institute for Virology, Private Bag X4, Sandringham 2131, South Africa Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 82, Issue 5, September-October 1988, Page 757, https://doi.org/10.1016/0035-9203(88)90227-1 Published: 01 September 1988 Article history Received: 19 April 1988 Accepted: 03 May 1988 Published: 01 September 1988