The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.

A cross-sectional analysis of factors associated with detection of oncogenic human papillomavirus in human immunodeficiency virus-infected and uninfected Kenyan women

Background

Cervical cancer is caused by oncogenic human papillomaviruses (HPV) and is one of the most common malignancies in women living in sub-Saharan Africa. Women infected with the human immunodeficiency virus (HIV) have a higher incidence of cervical cancer, but the full impact on HPV detection is not well understood, and associations of biological and behavioral factors with oncogenic HPV detection have not been fully examined. Therefore, a study was initiated to investigate factors that are associated with oncogenic HPV detection in Kenyan women.

Methods

Women without cervical dysplasia were enrolled in a longitudinal study. Data from enrollment are presented as a cross-sectional analysis. Demographic and behavioral data was collected, and HPV typing was performed on cervical swabs. HIV-uninfected women (n = 105) and HIV-infected women (n = 115) were compared for demographic and behavioral characteristics using t-tests, Chi-square tests, Wilcoxon sum rank tests or Fisher’s exact tests, and for HPV detection using logistic regression or negative binomial models adjusted for demographic and behavioral characteristics using SAS 9.4 software.

Results

Compared to HIV-uninfected women, HIV-infected women were older, had more lifetime sexual partners, were less likely to be married, were more likely to regularly use condoms, and were more likely to have detection of HPV 16, other oncogenic HPV types, and multiple oncogenic types. In addition to HIV, more lifetime sexual partners was associated with a higher number of oncogenic HPV types (aIRR 1.007, 95% CI 1.007–1.012). Greater travel distance to the clinic was associated with increased HPV detection (aOR for detection of ≥ 2 HPV types: 3.212, 95% CI 1.206–8.552). Older age (aOR for HPV 16 detection: 0.871, 95% CI 0.764–0.993) and more lifetime pregnancies (aOR for detection of oncogenic HPV types: 0.706, 95% CI, 0.565–0.883) were associated with reduced detection.

Conclusion

HIV infection, more lifetime sexual partners, and greater distance to health-care were associated with a higher risk of oncogenic HPV detection, in spite of ART use in those who were HIV-infected. Counseling of women about sexual practices, improved access to health-care facilities, and vaccination against HPV are all potentially important in reducing oncogenic HPV infections.

Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population

AIDS-associated morbidity has diminished due to excellent viral control. Multimorbidity are more prevalent and incident in Swiss HIV-positive persons compared to HIV-negative controls. However, smoking, but not HIV status, had a strong impact on cardiovascular risk and multimorbidity.

Background. Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population.

Methods. We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking.

Results. Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2–2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1–2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44–1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5–2.4; smoking: IRR = 2.0, 95% CI = 1.6–2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9–3.8; smoking: IRR = 2.6, 95% CI = 1.9–3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4–2.4; smoking: IRR = 1.7, 95% CI = 1.4–2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus.

Conclusions. Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.

Patient transfer to rehabilitation: just another move?

Although relocation stress syndrome (RSS) is not a diagnosis that is unique to rehabilitation patients, it is important for nurses practicing in rehabilitation environments to be knowledgeable about this phenomenon. Rehabilitation patients are at high risk for RSS. Nursing care planning should incorporate interventions that aim to prevent or reduce RSS. While various relocations are inherent in the rehabilitation process, emphasis should be placed on predictability of care and on patients and families having as much control over decision making as possible. The authors describe how appropriate assessment and management of RSS can facilitate smoother transitions throughout the rehabilitation process and permit a stronger focus on rehabilitation therapies and on patient and family teaching.

A Dictyostelium myosin I plays a crucial role in regulating the frequency of pseudopods formed on the substratum

Analysis of the motile behavior of a strain of Dictyostelium lacking a myosin I, myoA, revealed that this mutant strain formed pseudopods and turned twice as frequently as wild type cells [Titus et al., 1993: Mol. Biol. Cell 4:233-246]. The basis for this aberrant behavior has been explored using three-dimensional reconstructions of translocating cells. Wild type cells form approximately 40% of pseudopods on the substratum and 60% off the substratum. The majority of pseudopods formed on the substratum initiate sharp turns while the majority of pseudopods formed off the substratum are retracted. Although myoA- cells form pseudopods at roughly twice the frequency of wild type cells, the increase in frequency is specific for only those pseudopods formed on the substratum. This increase is the basis for the aberrant increase in turning in myoA- cells. The selective increase in the frequency of pseudopods formed on the substratum correlates with a number of additional abnormalities in myoA- pseuodpod formation. First, myoA- cells can simultaneously extend more than one pseudopod, whereas wild type cells extend only one pseudopod at a time. Second, although wild type and myoA- pseudopods achieve the same final volumes, myoA- pseudopods grow at half the rate of wild type pseudopods and, therefore, take longer to achieve final volume. Third, while a wild type pseudopod grows in a continuous fashion, a myoA- pseudopod grows in a discontinuous fashion. Together, these results demonstrate that myoA plays a fundamental role in controlling the frequency of only those pseudopods formed on the substratum, and that maintenance of the normal frequency of pseudopod formation appears to be necessary for the normal velocity of cellular translocation, the normal frequency of turning, the normal rate of average pseudopod growth, and the high efficiency of chemotaxis. These results in turn indicate that pseudopod formation is precisely coordinated in space and time, and actin-associated proteins like myoA play key roles in coordination.

Relocation stress syndrome. A patient and staff approach

Administrative articles addressing hospital mergers, renovations, and unit or departmental relocations can be found in nursing and healthcare literature. However, there is a paucity of information regarding the patients' needs, both before and after relocation, especially the integration of these needs in a comprehensive relocation plan. The authors present a successfully implemented relocation plan, highlighting the need for awareness of relocation stress syndrome.