Response of Black African patients with hepatitis C virus genotype 4 to treatment with peg-interferon and ribavirin

AIM

To compare responses to therapy of Black African (BA) and non-Black African (non- BA) patients with hepatitis C virus genotype 4 (HCV-4) residing in Belgium.

METHODS

In this retrospective multicenter study, 473 patients with HCV-4 were selected from databases at 7 Belgian centers; 209 treatment-naive patients (154 BA) had received treatment with peg-interferon (peg-IFN) plus ribavirin (RBV) and were included in the study.

RESULTS

There was a greater percentage of female patients in the BA group than in the non- BA group; BA patients were also older, had a greater body mass index, and more frequently had abnormal glucose metabolism. The route of contamination was more frequently unknown in BA than in non-BA patients and BA patients had more HCV-4 subtypes. There were no differences in other demographic factors between the groups. Sustained viral response (SVR) and complete early viral response rates were significantly lower and relapse rates significantly higher in BA than in non-BA patients. There were no differences between groups in rates of dose modification or in drug tolerance.

CONCLUSION

In our cohort, treatment-naive BA patients with HCV-4 who were treated with peg-IFN and ribavirin had a much lower SVR rate than treatment-naive non-BA patients with HCV-4 who were treated with peg-IFN and ribavirin, and a higher relapse rate, possibly related to a weaker response to interferon-based therapy. Treatment may need to be adapted in this population.

A biocultural approach to breastfeeding interactions in Central Africa

Anthropologists have long recognized that breastfeeding involves much more than feeding; it entails intimate social interactions between infants or children and their mothers. However, breastfeeding has predominantly been studied with respect to structural features (frequency, timing) as well as nutritional and health aspects of infant feeding. Thus, in this study we complement previous anthropological studies by examining social interactions that occur during breastfeeding among the Aka and Bofi foragers and Ngandu and Bofi farmers at various ages (three to four months, nine to ten months, toddlers). Further, we use an integrated biocultural perspective to explore how patterns of breastfeeding and social interactions can be shaped by economic constraints, cultural values, and children's development. Overall, our findings illustrate how biological and cultural factors interact and provide useful explanations of variations in breastfeeding structure and social interactions more so than either perspective alone.

The deleterious effects of physical inactivity on elements of insulin resistance and metabolic syndrome in Central Africans at high cardiovascular risk

AIM

We aimed to describe the physical activity and to investigate the association between classical hypertension, obesity, diabetes, and new inflammation, IDF-defined metabolic syndrome, insulin resistance CV risk factors.

DESIGN

This was a cross-sectional study based on interviews and physical and biochemistry measurements among Central African patients.

MEASUREMENTS

Waist circumference (WC), blood pressure, weight and height to calculate body mass index (BMI), fasting glucose, CRP, ERS, uric acid, cholesterol (C), LDL-C, HDL-C, triglycerides, elements of homeostatic model assessment (HOMA) including insulin, HOMA index, QUICKI, insulin sensitivity (%S), beta-cell function (%β) and insulin resistance (IR).

FINDINGS

Of the 60 patients included, 30 (50%) were physically inactive versus 30 (50%) active. In pooled analyses, in men and in women, there was significant and positive correlation between WC and seating/laying down position (WC=92.41+1.49 seating time in hours, R(2)=0.11; P<0.0001). The mean value of CRP and ERS were higher and those of all indices of HOMA were lower in inactive patients. The discriminant function for physical activity was Z (score=barycentre)=-7.36+1.013 HOMA index where -1.4 was the barycentre for active and +1.4 for inactive. HOMA index >2.42 was the optimal cut-off value to detect physically inactive patients: sensitivity=93.3%, specificity=100%, area under ROC=0.991±0.01 95%=0.975-1.0; P<0.0001.

CONCLUSION

The association between low-grade inflammation markers, insulin resistance and physical inactivity favours the hypothesis that a low-grade inflammatory status and enhanced insulin, sensitivity may constitute a part of the CV benefits from physical activity.

Chronic disease and its risk factors among refugees and asylees in Massachusetts, 2001-2005

INTRODUCTION

Better understanding of the health problems of refugees and people who are granted political asylum (asylees) in the United States may facilitate successful resettlement. We examined the prevalence of risk factors for and diagnoses of chronic disease among these groups in Massachusetts.

METHODS

We retrospectively analyzed health screening data from 4,239 adult refugees and asylees who arrived in Massachusetts from January 1, 2001, through December 31, 2005. We determined prevalence of obesity/overweight, hypertension, coronary artery disease (CAD), diabetes, and anemia. Analyses included multivariate logistic regression to determine associations between CAD and diabetes with region of origin.

RESULTS

Almost half of our sample (46.8%) was obese/overweight, and 22.6% had hypertension. CAD, diabetes, and anemia were documented in 3.7%, 3.1%, and 12.8%, respectively. People from the Europe and Central Asia region were more likely than those from other regions to have CAD (odds ratio, 5.55; 95% confidence interval, 2.95-10.47).

CONCLUSION

The prevalence of obesity/overweight and hypertension was high among refugees and asylees, but the prevalence of documented CAD and diabetes was low. We noted significant regional variations in prevalence of risk factors and chronic diseases. Future populations resettling in the United States should be linked to more resources to address their long-term health care needs and to receive culturally appropriate counseling on risk reduction.

Child slaves and freemen at the Spiritan Mission in Soyo, 1880-1885

Catholic missionaries in late nineteenth- and early twentieth-century Africa more commonly than Protestants purchased slaves to build their mission stations. This article provides a micro-historical analysis of the redemption of child slaves by the Holy Ghost Fathers in Soyo, West Central Africa, in the years immediately preceding the colonial partition of Africa. It argues that the Spiritan missionaries liberated slaves for instrumental rather than humanitarian reasons. As local freemen were difficult to control, the mission depended for its growth on the import of slave children. Furthermore, since the missionaries operated on the same markets and paid the same prices for slaves as regular buyers, their purchasing practices showed a strong resemblance with ordinary slave trading.

Paradox of precision: bright tobacco as technology of transfer, 1880-1937

This article compares two episodes of technology transfer in the 1890s: the movement of bright tobacco production technology to south-central Africa with the spread of the crop to eastern North Carolina and South Carolina. It finds similarities in the people who introduced the crop, but significant differences in the methods used to produce it. This is troubling because the type is defined by the cultivation and especially the curing techniques used to produce it; it is also often described in the historical literature as "Virginia tobacco," even when grown elsewhere. the technological differences are the product of different environments, which include not only the climate but also many elements of the technological system beyond immediate human control: the availability and organization of labor, differences in market structures and marketing institutions, and the government incentives provided to buyers. Therefore, this essay takes as its subject the paradox inherent in the official classification of tobacco types regulated by the USDA and argues that varietal types represent a form of market regulation disguised as botanical taxonomy.

Aggressive Periodontitis Among Young Israeli Army Personnel

BACKGROUND

The aim of this study was to assess the prevalence of aggressive periodontitis among young Israeli army recruits and to evaluate its association with smoking habits and ethnic origin.

METHODS

The study population consisted of 642 young army recruits (562 men [87.5%] and 80 women [12.5%]), aged 18 to 30 years (average: 19.6 +/- 1.6 years), who arrived at a military dental clinic for dental examinations between January and December 2004. Subjects filled out a questionnaire regarding their ethnic origin and family periodontal history, followed by radiographs and a clinical periodontal examination of four first molars and eight incisors.

RESULTS

Aggressive periodontitis was found in 5.9% of the subjects (4.3% localized and 1.6% generalized). At least one site with a probing depth > or =5 mm was found in 20.1% of the subjects. A radiographic distance between crestal bone height and the cemento-enamel junction >3 mm was found in 43 (6.7%) subjects. Current smokers (39.9%) (P = 0.03) and subjects of North African origin (P <0.0001) correlated with a high prevalence of aggressive periodontitis.

CONCLUSION

A relatively high prevalence of aggressive periodontitis was found in young Israeli army recruits, which was particularly associated with smoking and ethnic origin.

African hair growth parameters

BACKGROUND

Hair growth parameters have been studied mostly in caucasian hair, whereas few data on African hair have been reported in the literature.

OBJECTIVES

To evaluate hair growth characteristics of African volunteers born in Africa.

METHODS

Thirty-eight young adults (19 women, 19 men, mean +/- SD age 27 +/- 10 years), native of central and western Africa, took part in the study. Phototrichograms were performed in order to record three parameters of hair growth: hair density, telogen percentage and rate of growth. For each volunteer, three regions of the scalp, namely vertex, temporal and occipital areas, were assessed.

RESULTS

Hair density varied from 90 to 290 hairs cm(-2), with higher counts on the vertex. No significant difference between men and women was recorded. Telogen percentage showed wide variations, from 2 to 46%, with higher levels on the temporal area and in men. The rate of growth fluctuated from 150 to 363 microm day(-1) with no difference related either to gender or to scalp region. These data were compared with those previously obtained in caucasian volunteers of comparable age, and showed significant differences between the two ethnic groups in all three parameters studied. Hair density in African volunteers was lower than that in caucasians (mean +/- SD 190 +/- 40 and 227 +/- 55 hairs cm(-2), respectively). African hair grew at a much slower rate than caucasian hair (mean +/- SD 256 +/- 44 vs. 396 +/- 55 microm day(-1)), and telogen counts were frequently higher in African hair (mean +/- SD 18 +/- 9% vs. 14 +/- 11%).

CONCLUSIONS

This study demonstrated significant differences between African and caucasian hair growth parameters, which might suggest a trend towards increased hair loss in Africans, even though it contrasts with a lower and slower incidence of the development of alopecia in Africans.

A study on ten short tandem repeat systems: African immigrant and Spanish population data

This work presents the results obtained from a genetic-population study for the D1S1656 system in the population of Southwest Spain (Huelva, Cádiz and Sevilla), Spaniards of Caucasian origin from North Africa (Ceuta), as well as in the black Central West African and Moroccan immigrant populations in Spain. The results of a study of the autochtonous population of the Canary Islands (n=138), and immigrant Central West African populations in Spain (n=132), obtained for nine short tandem repeat (STR) loci (D3S1358, VWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S317, D7S820), as well as the amelogenin locus, all contained in Profiler Plus (Perkin-Elmer) PCR amplification kits, are also presented. Except for the FGA and VWA data on immigrant Central West African populations in Spain, no deviations from the Hardy-Weinberg equilibrium were detected.

Extent of heterogeneity in mitochondrial DNA of sub-Saharan African populations

Variation in the mitochondrial DNA (mtDNA) control region as detected by sequence-specific oligonucleotide (SSO) probes is described for 381 individuals from nine sub-Saharan African populations. Population diversity estimates for SSO types ranged from 0.23 to 0.97, while 102 SSO types were detected, none of these types was shared by more than four populations. Eighteen types occurred in > or = 10% of individuals in some populations; of these, 11 were population-specific. One type occurred in 15% of the total sample, but was shared among only three populations. African SSO types were characterized by high frequencies of blank variants, indicating that there was additional variation present at the nucleotide sequence level in regions where SSO probes hybridize. Analyses of molecular variance (AMOVA) incorporating genetic distances between SSO types showed that 30% of the total variation was due to differences among populations, indicating that there is statistically significant heterogeneity (p < 0.001). An AMOVA on mtDNA control region nucleotide sequence data from 12 populations showed that including all additional variation present at the sequence level increased the variance due to population subdivision to 34% (p < 0.001). Overall, when considering both the low diversity within some populations and high heterogeneity among populations, SSO typing of mtDNA may not be a desirable forensic DNA typing method for continental African populations. Further mtDNA sampling of African-derived populations of North America should be carried out to determine how much of the continental African mtDNA variation is of forensic significance. However, the existence of extensive mtDNA control region nucleotide sequence variation in African populations means that control region sequencing is still appropriate in forensic cases requiring mtDNA analysis.

Pulmonary tuberculosis in overseas students of higher education is increasing in Edinburgh

In Edinburgh in 1991 a relative excess of pulmonary TB cases in the 15-34 year age group was recorded. Five of 17 notifications in this age group were of overseas students of higher education: three aged 21-29 from Central Africa, one 27-year-old Asian and one 26-year-old Western European. One of the African students was seropositive for HIV infection. Disease presented clinically on average 31 months after entry to the U.K. (range 6-48 months). Four students had smear positive disease. Two patients had had normal chest radiographs 1 and 2 years previously on entry to the U.K.; three students had not previously been radiologically screened. We suggest that students from countries with a high prevalence of tuberculosis should be screened on entry to their course of education and that student health services should develop and maintain a high index of suspicion for tuberculosis in these students.

[Prevalence of antibodies to the hepatitis C virus in pregnant foreign residents in France]

Blood transfusion and intravenous drug use are the two main modes of transmission of the hepatitis C virus (HCV). Sexual intercourse seems to play a less significant part in transmission of the HCV and data are still lacking on vertical mother-to-offspring transmission. HCV seroprevalence was determined in 1,084 pregnant foreign residents of France living in a single city (Limoges). Antibodies to the HCV were detected in sera using both the first and second generation Abbott ELISA kits. Sera yielding reproducible positive results with either kit were retested with a blocking test (HCV EIA Neutralization, Abbott) and a second generation RIBA (Ortho) for confirmation. For screening, use of tests detecting both nonstructural and structural antibodies improved results noticeably (5 of 16 sera). Use of confirmation tests was found to be indispensable. Overall seroprevalence was 1.47%. However, results varied across geographic regions or origin, ranging from 0% for Europe, 1.9% for North Africa and 1.78% for South-East Asia, to 4.76% for black Africa. These findings demonstrated the potential for mother-to-offspring transmission among women from high prevalence areas. A prospective study in African an Asian women is being considered to evaluate ineffectiveness and transmission using serial serologic tests and viral genome detection by polymerase chain reaction studies (PCR).

[Bone density in 20 black African young adults of the Bantu race is identical to that in subjects of white race]

Bone mineral content (BMC in g) as well as bone mineral density (BMD in g/cm2) were measured by dual photon absorptiometry in 20 black africans and 20 white individuals of the same age and sex. The BMC of african males, as well as their body mass index (BMI), were significantly less than those of the whites. In contrast, neither BMD nor the ratio of BMC to BMI differed between the two groups. These results suggest that morphotype plays a greater role than the ethnic factor in the determination of bone mass in the young adult.

Long distance truck-drivers: 1. Prevalence of sexually transmitted diseases (STDs)

A cross section study was conducted among long distance truck drivers to determine the prevalence of sexually transmitted diseases (STDs) and antibodies to human immunodeficiency virus (HIV). A total of 8 drivers and their assistants en route from port of Mombasa to countries in East and Central Africa were enrolled into the study. Blood was taken for HIV and syphilis serology. Discharges from urethra and genital ulcer disease (GUD) were cultured. Seroprevalence for HIV was 18% and 4.6% for syphilis. Fifty percent of Neisseria Gonorrhea cultured were penicillinase producers. Most of the men with urethral discharge and all the GUD were culture negative, probably due to prior treatment. Lack of circumcision, past history of GUD and urethritis were significantly associated with HIV seroconversion.

[Abnormal hemoglobins in a Negroid population in Peru]

A study was performed on 100 blood samples from black people native of the Chincha province and living in Pueblo Nuevo Ica district, in Peru. No haematological abnormalities were seen in any of the cases. Upon haemoglobin electrophoresis, 8 carriers of abnormal haemoglobin were found, the A/S pattern appearing in 5 instances and the A/C pattern in 3. These 8 samples were subjected to deoxyhaemoglobin solubility tests and to differential solubility test with urea, the initial results being confirmed. These data correlate, in general terms with previous findings.

Risk factors for HIV seropositivity among people consulting for HIV antibody testing: a pilot surveillance study in Quebec

The surveillance of AIDS (acquired immune deficiency syndrome) through case reporting only reflects the epidemiologic features of HIV (human immunodeficiency virus) transmission a few years earlier and not the prevalence of HIV seropositivity. HIV infection is not a notifiable condition in Quebec. We were asked by the ministère de la Santé et des Services sociaux du Québec to perform a pilot project for the surveillance of HIV seropositivity using a network of sentinel physicians. From May 15, 1988, to Sept. 30, 1989, physicians from four collaborating centres collected data on the serologic status, demographic characteristics and risk factors for 4209 patients who underwent HIV antibody testing. Of the 3899 subjects included in the study 7.9% were HIV positive. Through logistic regression analysis the following variables were found to be significantly associated with HIV seropositivity: presence of HIV-related symptoms (prevalence odds ratio [POR] 36.5), origin from an endemic area (POR 9.1), homosexuality or bisexuality (POR 8.4), intravenous drug use (POR 4.2), male sex (POR 2.8), previous HIV antibody testing (POR 2.5) and previous sexually transmitted disease (POR 1.8). Over the study period we found a large increase in HIV seroprevalence among intravenous drug users (4.2% in 1988 to 19.0% in 1989) (p = 0.02). This increase might reflect a recent change in the epidemiologic pattern of HIV transmission in Quebec. Surveillance of HIV seropositivity through a network of sentinel physicians may be a reasonable alternative to mandatory reporting.

[The state of the oral cavity in persons infected with the human immunodeficiency virus]

The authors observed high incidence (100% among citizens of the USSR) and intensity of caries in 47 patients with diagnosed acquired HIV infection in the stage of symptom-free course and AIDS. In 2 persons out of 9 in symptom-free course of HIV infection an increase of mental lymph nodes has been observed. Significant changes of the mouth cavity mucosa were diagnosed in 67.1% of the patients. Gingivitis was observed three times as often than in the control group.

HIV-related deaths outside medical institutions in Stockholm

During a 3-year period (August 1st, 1985 to July 31st, 1988) a systematic investigation of medico-legal autopsy cases with regard to the presence of antibodies for HIV-virus was carried out at the Department of Forensic Medicine in Stockholm, Sweden. Prior to autopsy, blood samples were taken from femoral or subclavian veins and were investigated by use of ELISA-screening and Western blotting test. During the first year of study, HIV infection was demonstrated in 11 out of 3464 deaths (0.32%), during the second year in 29 out of 3483 deaths (0.83%), and during the last year in 13 out of 3107 deaths (0.42%). It was shown that 48 out of the total of 53 HIV positive cases were previously registered, but information about the infection was available to the autopsist in only 27 cases. Drug addicts dominated 41 of 53 cases. There were only eight homo- and bisexual males, two non drug addict Central Africans and two persons who received blood transfusions. Eight of the 53 persons died of natural causes whereas 45 deaths were due to violence and drugs. The causes of death of the HIV positive drug addicts were compared to the causes of death of the HIV negative addicts. The HIV positive drug addicts tended to die suddenly in connection with the intravenous administration of heroin and at lower blood concentrations of morphine more often than the HIV-negative addicts. No increase in the suicide frequency was noted in drug addicts in Stockholm during the studied period.

Salmonella bacteremia in African patients with human immunodeficiency virus infection

During a two-year period, 26 Central African patients with AIDS or AIDS-related complex were seen in two Belgian hospitals and five of these patients presented with non-typhoid Salmonella bacteremia. Three additional patients were observed in a Rwandese hospital. These eight African patients were compared with 16 non-AIDS patients with non-typhoid Salmonella bacteremias. The patients with AIDS or AIDS-related complex did not have gastroenteritis, but they did have a high recurrence rate and high prevalence of Salmonella typhimurium. Long-term antibiotic prophylaxis seems warranted for such patients despite the high frequency of side effects from antibiotics.

Human enzyme polymorphism in the Canary Islands. II. African influence

The genetic polymorphism of eight red cell enzymes was examined in three samples from Gran Canaria and one from Equatorial Guinea. The presence of African genes in the Gran Canaria population showed an African admixture estimated to 6-9%. The genetic distance between Gran Canaria and Equatorial Guinea was 0.033, and that between Gran Canaria and the Spanish mainland only 0.007.

[Antibodies against HIV-2 (LAV-II) in Africa and West Germany]

Antibodies against HIV-2 were tested by indirect immunofluorescence in over 2000 sera from Africa and the Federal Republic of Germany. The specificity of the test for HIV-2 was established by absorption of the sera with HIV-1 infected cells. Antibodies against HIV-2 were found in sera from two of 51 Africans who are living in the FRG. In addition, antibodies against HIV-2 were occasionally found in two of 1396 sera from Central Africa and two of 322 from West Africa. Cross-reacting antibodies were found in four of 189 high risk patients from the FRG who had HIV-1 infection, these antibodies no longer being present after absorption. It would therefore seem that HIV-2 infections are still rare among German risk groups.

[Geographic distribution of hematologic elements in Central African countries: distribution of the ABO blood group system]

1,559 people of various ethnical and geographical origin from the Central African Republic (CAR) have been tested for A, B, O group determination. Genic repartition is analysed, historic implications in human migrations are discussed.

[Interstitial lymphoid pneumonia and polyadenopathies in patients infected with the LAV/HTLV III virus]

Seven patients of Haitian and Central African origin were investigated for interstitial pneumonitis and unexplained chronic lymphadenopathy. A study of broncho-alveolar lavage fluid showed no opportunistic micro-organisms and disclosed a high alveolar lymphocyte count with more than 80% T8+ cells. In 3 patients, open lung biopsy showed lymphoid interstitial pneumonitis. Follicular hyperplasia was a constant finding in lymph nodes. Benign lymphocytic infiltration was found in other organs of all patients, associated with polyclonal hyperimmunoglobulinaemia, low peripheral T4+ cell count and LAV-Ig G antibodies.

Acquired immune deficiency syndrome in Belgium and its relation to Central Africa

During the years from 1979 until 1983, 40 cases of CDC-defined AIDS were seen in Belgium. Only two patients were Belgian male homosexuals. The other patients were Central Africans who lived in Belgium or who had travelled to Belgium for medical care. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. The male:female ratio was 1.5. All patients had opportunistic infections. Five of them also had Kaposi's sarcoma. All patients tested had immunologic features of severe T-cell depression. The overall mortality was 42.5 percent. It is likely that AIDS is endemic now in Central Africa, and that the cases seen in Belgium represent only the tip of the iceberg.

Acquired immunodeficiency syndrome in African patients

Between May 1979 and April 1983, 18 previously healthy African patients were hospitalized in Belgium with opportunistic infections (cryptococcosis, Pneumocystis carinii pneumonia, central-nervous-system toxoplasmosis, progressive cutaneous herpes simplex virus infection, disseminated cytomegalovirus infection, candidiasis, or cryptosporidiosis) or Kaposi's sarcoma, or with both. Ten of them died. During the same period five other patients were hospitalized with an illness consistent with a prodrome of the acquired immunodeficiency syndrome (chronic lymphadenopathy, fever, weight loss, and diarrhea). All patients tested had a marked decrease in helper T cells; an inversion of the normal ratio of helper to suppressor T cells, and a decreased or absent blastogenic response of lymphocytes to mitogens. Twenty patients had anergy. There was no evidence of an underlying immunosuppressive disease and no history of blood-product transfusion, homosexuality, or intravenous-drug abuse. This syndrome in patients originating in Central Africa is similar to the acquired immunodeficiency syndrome reported in American patients.