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Brief Encounters
  1. Rob Miller, Editor

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    As part of our ongoing Tropical Medicine series (Edited by Assistant Editor, David Lewis) Paz-Bailey and colleagues review the epidemiology and management of Herpes simplex type-2 (HSV-2) infection in the developing world. They identify several important issues. First, that HSV-2 is highly prevalent worldwide and is an increasingly important cause of genital ulcer disease (GUD). Second, continued HSV-2 transmission is facilitated by the large number of undiagnosed cases, the frequency of atypical disease and the occurrence of asymptomatic shedding. Third, in low- and middle-income countries the lack of easy, affordable diagnostic tests and of specific antiviral therapy are of concern, given the ability of HSV-2 and other causes of GUD to enhance acquisition and transmission of HIV. This review highlights that a safe and effective vaccine is needed, together with locally-delivered multi-faced interventions to improve clinical recognition of genital herpes infection, in order to prevent the spread of HSV-2 and further to reduce its role as a promoter of HIV infection in developing countries.
 See p 16


    Tobacco and HIV/AIDS represent the only two major global causes of death that continue to grow. In the UK almost twice as many HIV-infected men aged <35 years smoke tobacco compared with aged-matched HIV-negative men. Furber and colleagues present a systematic review of studies exploring tobacco smoking as a risk factor for either acquisition of HIV (surrogate marker  =  seroconversion) or progression to AIDS. Of six studies with HIV seroconversion as the outcome, five indicated smoking as an independent risk factor for acquiring HIV infection. After adjusting for confounders adjusted odds ratios for tobacco smoking as an independent risk factor for acquiring HIV infection were between 1.6 and 3.5. In contrast, nine of 10 studies which used progression to AIDS as an outcome found no association between HIV disease progression and tobacco smoking. The authors conclude that tobacco smoking may be an independent risk factor for acquisition of HIV infection, although residual confounders may be an alternative explanation. Although smoking is not related to progression to AIDS, the authors hypothesise that this may not be the case in developing countries, or in the context of longer life expectancies seen in populations with access to highly active antiretroviral therapy. The authors’ hypothesis is supported by recent reports of an increase in chronic obstructive pulmonary disease and (smoking-related) deaths from lung cancer in several HIV-infected cohorts. These data demonstrate that tobacco smoking-cessation/avoidance is an important component of health promotion for HIV-infected patients.
 See p 41


    Although the majority of HIV-infected persons in South Africa have not been tested (for HIV infection) and are unaware of their HIV serostatus, uptake of HIV testing is increasing as antiretroviral therapy becomes available. There is a growing need for HIV prevention interventions for people who have been found to have HIV infection. The authors performed an anonymous survey of 1027 HIV-infected adults attending HIV services. Of these patients 85% were sexually active; in the last 3 months 42% had sex with a person to whom they had not disclosed their HIV status. Non-disclosure was associated with recent loss of job or accommodation because of being HIV infected. Those who had not disclosed were more likely to have multiple partners, HIV negative or partners of uncertain status and to have unprotected sex. The authors conclude that interventions are needed in South Africa to reduce AIDS stigma/discrimination in order to assist people living with HIV to make effective disclosure decisions and to reduce HIV-transmission risk behaviour.
 See p 29


    Patients receiving human normal immunoglobulin (HNIG) which is derived from pooled donated plasma may subsequently have misleading serological results for a variety of viral and bacterial infections. Constable and colleagues describe a 32-year-old man who received HNIG as treatment of Gullian-Barre syndrome. The patient had no clinical evidence of syphilis and no history of syphilis exposure. Immediately after HNIG therapy positive syphilis serology was identified: enzyme immunoassay (EIA) positive, Treponema pallidum haemagglutination assay (TPHA) positive (titre 1:320), rapid plasma reagin (RPR) negative. Reference laboratory testing showed fluorescent treponemal antibody-absorbed test positive, EIA positive, and treponemal particle agglutination test positive (titre 1:160). Serology was interpreted as suggesting previous, non-active/current infection. Repeat serological testing at 8 and 13 weeks after HNIG showed that EIA, TPHA and RPR were negative. The authors conclude that the chronology of testing infers their patient passively acquired treponemal antibodies. This case is important for clinicians as it highlights the potential for clinical confusion and misinterpretation of serological testing after a patient’s receipt of HNIG.
 See p 57

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