HIV treatment is associated with a two-fold higher probability of raised triglycerides: Pooled Analyses in 21 023 individuals in sub-Saharan Africa

BACKGROUND

Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.

METHODS

Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.

FINDINGS

Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.

INTERPRETATION

Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

H3Africa multi-centre study of the prevalence and environmental and genetic determinants of type 2 diabetes in sub-Saharan Africa: study protocol

The burden and aetiology of type 2 diabetes (T2D) and its microvascular complications may be influenced by varying behavioural and lifestyle environments as well as by genetic susceptibility. These aspects of the epidemiology of T2D have not been reliably clarified in sub-Saharan Africa (SSA), highlighting the need for context-specific epidemiological studies with the statistical resolution to inform potential preventative and therapeutic strategies. Therefore, as part of the Human Heredity and Health in Africa (H3Africa) initiative, we designed a multi-site study comprising case collections and population-based surveys at 11 sites in eight countries across SSA. The goal is to recruit up to 6000 T2D participants and 6000 control participants. We will collect questionnaire data, biophysical measurements and biological samples for chronic disease traits, risk factors and genetic data on all study participants. Through integrating epidemiological and genomic techniques, the study provides a framework for assessing the burden, spectrum and environmental and genetic risk factors for T2D and its complications across SSA. With established mechanisms for fieldwork, data and sample collection and management, data-sharing and consent for re-approaching participants, the study will be a resource for future research studies, including longitudinal studies, prospective case ascertainment of incident disease and interventional studies.

Food intake increases liver stiffness measurements and hampers reliable values in patients with chronic hepatitis B and healthy controls: the PROLIFICA experience in The Gambia

BACKGROUND

By increasing the hepatic blood circulation, food intake has been suggested to increase liver stiffness measurement (LSM) values in HCV-infected patients.

AIM

To investigate prospectively the effects of food intake on LSM in hepatitis B virus (HBV)-infected patients and healthy controls.

METHODS

In The Gambia, patients included in the PROLIFICA project are screened for HBV at the community level and then invited for fasting assessment including LSM. Between April 2012 and October 2012, each day, the first five participants were invited to participate in this study. After the initial examination, a standardised 850 Kcal breakfast was provided. Effect of food intake was assessed by examining mean difference of LSM, IQR and IQR/LSM at T0 (fasting LSM1), T30min (LSM2) and T120min (LSM3) respectively.

RESULTS

A total of 209 subjects were enrolled in this study (133 were HBV positive, 76 healthy controls). Unreliable measurements occurred more frequently after food intake (5%, 24% and 18% at T0, T30min and T120min respectively). In both groups, median LSM2 was significantly higher than LSM1 [6.2 (IQR: 5.4, 7.9)] vs. 4.9 (4.2, 6.2), P < 0.0001. LSM3 was still higher than the baseline, but lower than LSM2. In multivariable analysis, no factor modified the effect of breakfast on LSM. In a subgroup of patients having liver biopsies, we confirmed that food intake can overestimate liver fibrosis.

CONCLUSIONS

Food intake significantly increases liver stiffness measurement and its IQR values in patients with chronic hepatitis B as well as healthy individuals; and also the number of unreliable liver stiffness measurement values.

Epilepsy is not caused by cysticercosis in The Gambia

OBJECTIVE

To determine whether epilepsy is caused by Taenia solium cysticercosis in The Gambia.

METHODS

Case-control study testing samples collected from 210 people with epilepsy and 420 matched controls by sex and age +/-5 years from 69 different places around the country during the period October 2008-March 2009. All serum samples were subjected to an antigen detection ELISA (Ag-ELISA) and electro-immunotransfer blot (EITB), and the seropositives were further CT-scanned to determine the presence of cysticerci in the brain.

RESULTS

Although not significantly different (P = 0.668), circulating Taenia antigen was found by Ag-ELISA in 1.4% (95% CI: 0.3-4.1) of people with epilepsy and in 1.9% (95% CI: 0.8-3.7) of the controls. A non-significant (P = 0.4718) odds ratio of association 0.75 (95% CI: 0.13-3.15) between epilepsy and the presence of Taenia antigens was found. All 630 serum samples turned out seronegative by the EITB test. There were no intracranial cysts or cyst-like structures detected among the nine CT-scanned Ag-ELISA seropositives.

CONCLUSION

Epilepsy appears not to be caused by cysticercosis in The Gambia.

Effects of interferon gamma and saponin on lymphocyte traffic are inversely related to adjuvanticity and enhancement of MHC class II expression

Interferon gamma (IFN-gamma) is an effective immunological adjuvant when mixed with vaccines prior to injection, but the way in which it exerts this effect has been unclear. Because some adjuvants have been shown to affect lymphocyte traffic, and interferons have been shown to have effects on lymphocyte homing molecules, we examine in this study the effects of IFN-gamma and the potent adjuvant saponin on lymphocyte traffic, and show that both of these adjuvants increase lymphocyte homing to an injection site in mice. We have then compared effects on lymphocyte traffic and on MHC class II expression with adjuvant effects in different mouse strains. Effects on lymphocyte traffic were the inverse of adjuvant effects in different strains, however both materials enhanced MHC class II expression, and this enhancement corresponded with adjuvanticity in different strains of mice. A possible explanation for the negative effect of lymphocyte homing may be that the vast majority of T cells homing to the injection sites in response to both IFN-gamma and saponin were of the CD8+ (suppressor/cytotoxic) phenotype.