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Early initiation of antiretroviral therapy is an important aspect in the care of patients with HIV. In a randomized trial, a low prophylactic dose of prednisone was shown to prevent paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in HIV-infected patients.

Background: An epilepsy prevalence of 4.4% was documented in onchocerciasis-endemic villages close to the Maridi River in South Sudan. We investigated the role of the Maridi dam in causing an onchocerciasis-associated epilepsy epidemic in these villages. Methods: Affected communities were visited in November 2019 to conduct focus group discussions with village elders and assess the OV16 seroprevalence in 3- to 9-year-old children. Entomological assessments to map blackfly breeding sites and determine biting rates around the Maridi River were conducted. Historical data regarding various activities at the Maridi dam were obtained from the administrative authorities. Results: The Maridi dam was constructed in 1954–1955. Village elders reported an increasing number of children developing epilepsy, including nodding syndrome, from the early 1990s. Kazana 2 (the village closest to the dam; epilepsy prevalence 11.9%) had the highest OV16 seroprevalence: 40.0% among children 3–6 years old and 66.7% among children 7–9 years old. The Maridi dam spillway was found to be the only Simulium damnosum breeding site along the river, with biting rates reaching 202 flies/man/h. Conclusion: Onchocerciasis transmission rates are high in Maridi. Suitable breeding conditions at the Maridi dam, coupled with suboptimal onchocerciasis control measures, have probably played a major role in causing an epilepsy (including nodding syndrome) epidemic in the Maridi area.

Mvolo in Western Equatoria of South Sudan has been a hotspot for transmission since the 1940s. In Mvolo onchocerciasis is a disease of public health importance, associated with onchocerciasis-associated epilepsy including nodding syndrome. We conducted an entomological study to map the breeding sites of blackflies (Simulium damnosum, sens lato) on the river Naam, to allow the removal of vegetation from vector breeding sites, the \"slash and clear\". Three blackfly catching sites were established along the river. Focus group discussions were also conducted to assess the willingness of the communities to support the \"slash and clear\" intervention and the semi-annual distribution of ivermectin. A total of 2466 female s.l. were caught in 14×11h (06.00-15.00) catches. The highest biting density of 4210.25 flies/month/h and monthly biting rate (MBR) of 11,482.25 bites/man/month were observed in November 2023. Biting density and MBR reduced to zero in the intervention site by April 2024. While the mean parity rate was 31% (CI: 0.2976±0.9176). Two diurnal biting peaks were observed, one from 9:00-10:00 (at the bridge site) and a prominent one from 14:00-15:00 in the two catching sites in Mvolo. Along the river Naam, only one site was found productive for s.l.; and the larvae and adults were morphologically associated with the anthropophilic . The \"slash and clear\" intervention was implemented at Dogoyabolu along the river Naam. Communities expressed willingness to support a \"slash and clear\" intervention and the semi-annual distribution of ivermectin. active breeding was identified along the river Naam in a stretch of 3-5 km close to human settlements. Highest blackfly biting density was 4210.25 flies/month/h, and two fly biting peaks were observed. A community \"slash and clear\" vector control was implemented, and will be prospectively monitored.

A woman is described who developed fear of flying because she took mefloquine as malaria prophylaxis prior to the flight. Mefloquine, because of its potential neurotoxicity, should not be used for persons with fear of flying.

Hepatitis B (HBV) in sub-Saharan Africa is believed to be horizontally acquired. However, because of the high HBV prevalence in northern Uganda, no hepatitis B vaccination at birth and no access to HBV immunoglobulin, we hypothesize that vertical transmission also could also play an important role. We therefore investigated the incidence of HBV among babies presenting for their first HBV vaccine dose in Gulu, Uganda. We recruited mothers and their babies (at least 6-week old) presenting for their postnatal care and first HBV vaccine dose respectively. Socio-demographic and risk factors for HBV transmission were recorded. Mothers were tested for Hepatitis B core antibody (anti-HBc-IgG) and hepatitis B surface antigen (HBsAg). HBsAg-positive sera were tested for hepatitis B e antigen (HBeAg) and HBV viral load (HBVDNA). Babies were tested for HBsAg at presentation and at the last immunization visit. A sample of HBsAg-negative babies were tested for HBVDNA. Incident HBV infection was defined by either a positive HBsAg or HBVDNA test. Chi-square or fisher’s exact tests were utilized to investigate associations and t-tests or Wilcoxon rank-sum test for continuous differences. We recruited 612 mothers, median age 23years (IQR 20–28). 53 (8.7%) were HBsAg-positive and 339 (61.5%) were anti-HBc-IgG-positive. Ten (18.9%) of the HBsAg-positive mothers were HBeAg-positive. Median HBVDNA levels of HBV-infected mothers was 5.7log (IQR 4.6–7.0) IU/mL with 9 (17.6%) having levels≥105IU/mL. Eighty (13.3%) mothers were HIV-infected of whom 9 (11.5%) were co-infected with HBV. No baby tested HBsAg or HBVDNA positive. Vertical transmission does not seem to contribute substantially to the high HBV endemicity in northern Uganda. The current practice of administering the first HBV vaccine to babies in Uganda at six weeks of age may be adequate in control of HBV transmission.

Raga County is an onchocerciasis-endemic area in the Western Bahr El Ghazal state of South Sudan, known to have a high prevalence of blindness. The objective of this study was to determine the causes of eye disease and blindness in Raga County as well as to assess the relationship of eye diseases with other prevalent conditions like onchocerciasis and epilepsy. We reviewed unpublished pre-community directed treatment with ivermectin (CDTI) data about eye disease and onchocerciasis in Western Bahr El Ghazal including Raga. In addition, a cross-sectional study was conducted from 21 March to 2 April 2023 in 11 villages in Raga County. Participants were persons with blindness or other eye/vision problems, recruited via a community-based approach. Two senior ophthalmic clinical officers, supervised by an experienced ophthalmologist, performed the following assessments on participants: visual acuity measurement with Snellen Charts, anterior chamber examination with a loupe, and fundoscopy to assess the posterior segment with direct and indirect ophthalmoscopes. Pre-CDTI data showed that the most severe vision problems in villages with a high prevalence of infection were caused by onchocerciasis eye disease. During the 2023 survey, in total, 1559 persons (3,118 eyes) were examined (mean age: 47 ± 19.2 years, 58.4% male). The most frequent eye diagnosis was allergic conjunctivitis, observed in 1453 (46.6%) eyes of the participants. The main causes of blindness were onchocerciasis-related blindness (22.6%, caused by onchocerciasis chorioretinitis (9.4%), sclerosing keratitis, punctate keratitis (5.6%), and onchocerciasis optic neuropathy (7.6%)), and cataract (9.3%). A significantly higher proportion of persons with epilepsy presented with clinical signs of onchocerciasis including blindness (53.2%), compared to persons without epilepsy (32.5%) (p = 0.0007). Despite years of CDTI, the main causes of blindness in Raga County remain onchocerciasis-related blindness observed in 22.6% and cataract observed in 9.3% of the study participants. The study confirmed an epidemiological association between onchocerciasis and epilepsy.

A high level of adherence to antiretroviral treatment is essential for optimal clinical outcomes in HIV infection, but measuring adherence is difficult. We investigated whether responses to a questionnaire eliciting caregiver beliefs in medicines were associated with adherence of their child (median age 2.8 years), and whether this in turn was associated with viral suppression. We used the validated beliefs in medicine questionnaire (BMQ) to measure caregiver beliefs, and medication event monitoring system caps to measure adherence. We found significant associations between BMQ scores and adherence, and between adherence and viral suppression. Among children initiating Antiretroviral therapy (ART), we also found significant associations between BMQ ‘necessity’ scores, and BMQ ‘necessity-concerns’ scores, and later viral suppression. This suggests that the BMQ may be a valuable tool when used alongside other adherence measures, and that it remains important to keep caregivers well informed about the long-term necessity of their child’s ART.

This study determined risk factors for decreased sexual satisfaction among men living with HIV (MLHIV). Self-administered questionnaires were distributed consecutively to all MLHIV attending 17 European HIV treatment centres. The sample included 1,017 MLHIV, among whom 79.2% self-identified as homosexual or bisexual. Sexual satisfaction was measured for five domains of sexual functioning and 33.2% reported low satisfaction in at least one domain. Decreased sexual satisfaction was associated with psychosocial factors, i.e. depression (OR 2.77, P  < 0.001), anxiety (OR 1.77, P  < 0.001), stress (OR 2.27, P  < 0.001) and social factors, such as low partner support (OR 2.28, P  < 0.001) and experiences of HIV related discrimination (OR 1.69, P  < 0.001). Discussing satisfaction with sexuality should be integrated in regular HIV care, considering patients’ personal and relationship-related resources next to medical treatment if indicated.

Between 6 and 22 June 1995, 8 patients in Kikwit, Democratic Republic of the Congo, who met the case definition used in Kikwit for Ebola (EBO) hemorrhagic fever, were transfused with blood donated by 5 convalescent patients. The donated blood contained IgG EBO antibodies but no EBO antigen. EBO antigens were detected in all the transfusion recipients just before transfusion. The 8 transfused patients had clinical symptoms similar to those of other EBO patients seen during the epidemic. All were seriously ill with severe asthenia, 4 presented with hemorrhagic manifestations, and 2 became comatose as their disease progressed. Only 1 transfused patient (12.5%) died; this number is significantly lower than the overall case fatality rate (80%) for the EBO epidemic in Kikwit and than the rates for other EBO epidemics. The reason for this low fatality rate remains to be explained. The transfused patients did receive better care than those in the initial phase of the epidemic. Plans should be made to prepare for a more thorough evaluation of passive immune therapy during a new EBO outbreak.