Open Access Publications

Open Access HIV & TB PublicationsThe Victor Daitz Information Gateway provides financial support to HIV and TB researchers at the University of KwaZulu-Natal wishing to publish papers in Open Access journals. The list of Open Access articles below are papers published with the support of the Victor Daitz Information Gateway.

  • Cumming BM, Rahman MA, Lamprecht DA, Rohde KH, Saini V, Adamson JH, Russell DG, Steyn AJC

    PLOS Pathogens, Vol 13, Issue 7, 05/2017

    Mycobacterium tuberculosis (Mtb) is responsible for the estimated 1.8 million people with tuberculosis. One of the reasons for the success of this pathogen is its ability to modulate the immune system and establish a persistent infection. The manner whereby the mycobacterium senses the environment and modulates the host immune system is poorly understood. In this study, we used transcriptional analyses of both Mtb and the infected macrophage to ascertain mechanisms whereby Mtb adapts to and resides in macrophages. We found that WhiB3, a redox sensor in Mtb that controls virulence lipid production, is also involved in modulating the mycobacterium’s energy metabolic pathways in response to available carbon sources. As redox homeostasis regulates the virulent lipid production in Mtb, and the oxido-reductive homeostasis is tightly coupled with bioenergetic homeostasis, the virulent lipid production will be dependent on bioenergetic homeostasis. From the host’s perspective, transcriptional analysis revealed that Mtb regulates the macrophage’s cell cycle and comprehensive cell cycle analysis indicated that Mtb arrested the macrophages’ cell cycle. We discovered that polyketides under Mtb WhiB3 control were responsible for this cell cycle arrest that will potentially modulate the immune response to this intracellular pathogen. These studies reveal a novel strategy of targeting the host cell cycle for chemotherapeutic intervention.

  • Olamide Todowede & Benn Sartorius

    BMJ Open, Vol 7, Issue 7, 07/2017

    Metabolic disorder and high blood pressure are common complications globally, and specifically among people living with HIV (PLHIV). Diabetes, metabolic syndrome and hypertension are major risk factors for cardiovascular diseases and their related complications. However, the burden of metabolic syndrome, discrete or comorbid diabetes and hypertension in PLHIV compared with HIV-negative population has not been quantified. This review and meta-analysis aims to compare and analyse the prevalence of these trio conditions between HIV-negative and HIV-positive populations in sub-Saharan Africa (SSA).

    The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guides the methods for this study. Eligibility criteria will be published original articles (English and French language) from SSA that present the prevalence of metabolic syndrome, discrete and/or comorbid diabetes, and hypertension comparisons between PLHIV and HIV-negative populations. The following databases will be searched from January 1990 to February 2017: PubMed/Medline, EBSCOhost, Web of Science, Google Scholar, Scopus, African Index Medicus and Cochrane Database of Systematic Reviews. Eligibility screening and data extraction will be conducted independently by two reviewers, and disagreements resolved by an independent reviewer. Methodological quality and risk of bias will be assessed for individual included studies, while meta-analysis will be used to estimate study outcomes prevalence according to subgroups. Sensitivity analysis will also be performed to further test the robustness of the findings.

  • Christina C Chang, Richard Kangethe, Saleha Omarjee, Keshni Hiramen, Bernadett Gosnell, Katlego Sojane, Mohamed-Yunus S Moosa, Sharon R Lewin, Martyn A French, Thumbi Ndung’u

    Open Forum Infectious Diseases, Vol 4, Issue 2, 02/2017

    We measured human immunodeficiency virus (HIV) ribonucleic acid (RNA) in paired cerebrospinal fluid (CSF) and plasma samples in a prospective study of 91 HIV-infected, antiretroviral therapy-naive patients with cryptococcal meningitis. Cerebrospinal fluid HIV RNA was lower than in plasma (median 4.7 vs 5.2 log10 copies/mL, P < .0001) and positively correlated with plasma HIV RNA, peripheral CD4+ T-cell percentage, and CSF CXCL10. Plasma/CSF ratio of HIV RNA ranged widely from 0.2 to 265.5 with a median of 2.6. Cerebrospinal fluid quantitative cryptococcal culture positively correlated with CSF CCL2 and CCL3. CSF-plasma viral discordance was not associated with cryptococcal-associated immune reconstitution inflammatory syndrome.

  • Manimbulu Nlooto

    PLoS One, Vol 12, Issue 2, 02/2017

    A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis.

    Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained of ARVs related side-effects. Forty-five percent of those with side-effects (141/311, 45.34%) reported taking various types of medicines for treating side-effects, with 90.07% of them (127/141) using medicines prescribed by biomedically trained doctors or by pharmacy personnel as over-the -counter medicines, p <0. 001. Very few participants (14/141, 9.93%) resorted to the use of traditional medicine for treating side effects associated with antiretroviral therapy with no significant difference (p=0.293). In a multiple logistic regression, after adjusting for age, gender, race and side-effects due to antiretroviral therapy, odds for using traditional medicine were almost two times higher [odds ratio = 1.884, 95% Confidence Interval 1.317–2.695] with those participants having comorbidities and co-infections, with a significant difference p-value< 0.001.

    Comorbidities, co-infections and side effects are prevalent among HIV-infected patients attending public sector healthcare facilities. Odds of using traditional medicine were almost two times higher and significantly associated with the presence of comorbidities and co-infections than for other factors. The presence of such comorbid health problems does not explain the increased use of traditional medicine among HIV-infected patients on antiretroviral therapy. Findings from this study should be interpreted cautiously as they cannot be generalized to the entire population of HIV-infected patients in KwaZulu-Natal. Studies on safety and efficacy of herbal traditional medicines are needed for beneficiation of the minority of patients who still resort to them for co-treatment with combination antiretroviral therapy.

  • Ginindza TG, Dlamini X, Almonte M, Herrero R, Jolly PE, Tsoka-Gwegweni JM, Weiderpass E, Broutet N, Sartorius B

    PLoS One, Vol 12, Issue 1, 01/2017

    High risk human papillomavirus (hr-HPV) infection and the dual burden of HIV remains a huge challenge in some low-income countries (LICs) such as Swaziland with limited or no data. We estimated the prevalence and investigated determinants of hr-HPV, including HIV infection among sexually active women in Swaziland.

    A total of 655 women aged between 15 and 49 years from five health facilities were randomly enrolled using a cross-sectional study design. Cervical cells were tested for hr-HPV types using GeneXpert HPV Assays.

    The overall weighted hr-HPV prevalence was 46.2% (95%CI: 42.8–49.5). Of hr-HPV infected women, 12.4% (95%CI: 8.6–17.5) were HPV16-positive, 13.8% (95%CI:12.0–15.8) were positive for HPV18/45, 26.7% (95%CI: 24.2–29.3) for HPV31/33/35/52/58, 7.6% (95%CI: 7.6–11.9) for HPV51/59 and 11.0%, (95%CI: 7.9–15.3) for HPV39/56/66/68. Prevalence of hr-HPV decreased with increasing age. Overall HIV prevalence remained high (42.7%; 95%CI: 35.7–46.2). HIV infection was associated with hr-HPV infection (Adjusted OR = 4.9, 95%CI: 3.043–7.8, p<0.001). Overall hr-HPV/HIV co-infection was 24.4% (95%CI: 20.3–29.1) which was significantly higher among younger age groups (p<0.001). Prevalence of multiple group hr-HPV infection was significantly higher in HIV-positive versus -negative women (27.7% and 12.7% respectively, p<0.001). The presence, absence or unknown of history of STI with HIV did not appear to modify the relationship with hr-HPV (OR = 4.2, 95%CI: 2.6–7.1, OR = 4.6, 95%CI: 2.8–7.7, p<0.001, p<0.001 and OR = 4.1, 95%CI: 1.3–13.4, p<0.021 respectively).

    The prevalence of hr-HPV infection was high and significantly associated with HIV among sexually active women. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections which may explain the high prevalence among HIV infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV infected people.