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Geneva, Switzerland, WHO, 2009 Nov. 25 p.Based on the latest scientific evidence, the World Health Organization (WHO) has released new recommendations on HIV treatment and prevention and infant feeding in the context of HIV. WHO now recommends earlier initiation of antiretroviral therapy for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.
Are a past history of tuberculosis and WHO clinical stage associated with incident tuberculosis in adults receiving antiretroviral therapy? [letter [reply]
AIDS. 2007 Jan; 21(3):389-390.In two recent excellent articles, Lawn and colleagues [1,2] reported the incidence and risk factors for active tuberculosis among HIV-infected adults receiving antiretroviral therapy (ART) in South Africa. In both studies, they found contradictory results regarding the association between the baseline World Health Organization (WHO) clinical stage and the occurrence of incident tuberculosis during follow-up, and contradictory trends towards an association between a past history of tuberculosis at enrolment and a lower (first study) or higher (second study) incidence of tuberculosis during follow-up. (excerpt)
DOTS versus self administered therapy (SAT) for patients of pulmonary tuberculosis: a randomised trial at a tertiary care hospital.
Indian Journal of Medical Sciences. 2002 Jan; 56(1):19-21.Tuberculosis is a major public health problem in India, and it is being made worse by poor adherence to and frequent interruption of antitubercular treatment. Directly observed therapy short course (DOTS), is one of the key elements in the WHO global tuberculosis control programme strategy and has been widely publicized as a breakthrough and strongly promoted globally by WHO. However little or no randomised data exists of comparison between DOTS versus self administered therapy (SAT). The present study is an effort in this direction to compare adherence and outcome after random allocation of patients to directly observed therapy (DOTS) or self administered therapy (SAT). (author's)
Vitamin A deficiency and increased mortality among human immunodeficiency virus-infected adults in Uganda.
Nutrition Research. 2003 May; 23(5):595-605.The specific aims of the study were to determine the prevalence of vitamin A deficiency and to examine the relationship between vitamin A deficiency and mortality among human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. A prospective cohort study was conducted at the outpatient clinic of Mulago Hospital, Kampala, Uganda, among HIV-infected adults enrolled in the placebo arms of a randomized clinical trial to prevent Mycobacterium tuberculosis infection. Of 519 subjects at enrollment, 186 (36%) had serum vitamin A concentrations consistent with deficiency (<1.05 µmol/L). During follow-up (median 17 months), the mortality among subjects with and without vitamin A deficiency at enrollment was 30% and 17%, respectively (P = 0.01). In a multivariate model adjusting for CD4+ lymphocyte count, age, sex, anergy status, body mass index, and diarrhea, vitamin A deficiency was associated with a significantly elevated risk of death [relative risk (RR) = 1.78, 95% confidence interval (CI) 1.2-2.6]. Vitamin A deficiency is common among HIV-infected adults in this sub-Saharan population and is associated with higher mortality. (author's)
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1992; 70(1):17-21.The impact of tuberculosis, the leading cause of death from a single infectious agent in the world, warrants a global control program. Every year, some 8 million people worldwide contract tuberculosis. Some 3 million die from it. It is estimated that 1/4 of all avoidable adult (15-59 years) deaths in the developing world each year are due to tuberculosis, meaning that the diseases represents one of greatest impediments to social and economic development. 2 recent developments have aggravated the tuberculosis problem: 1) the epidemic of HIV infection, which increases the risk that a tuberculosis infection will progress to disease; and 2) the appearance of strains that are resistent the major drugs used for the treatment of tuberculosis (isoniazid and rifampicin). Nonetheless, there currently exist effective tools for controlling tuberculosis, including the BCG vaccine and chemotherapy. Highly cost-effective, a well-managed chemotherapy treatment can cure almost any patient rapidly and render sputum-positive cases noninfectious, thereby reducing the transmission of the infection. Despite the existence of effective and cost-effective treatment methods, most countries have made little progress in combating the disease and the international community has given scant support. Given the magnitude of the problem, a global program for the control of tuberculosis is needed. Such a program should include advocacy, research, and capacity building, and should set as its target goal a 70% detection rate of all new cases and an 85% cure rate by the year 2000. Such a program would cost approximately $200 million a year, but would represent one of the most advantageous health investments possible.