Poster Session : PS 0404 ; Infectious Disease ; Condom Use Behaviour for Women, Harm Reduction and HIV.

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: This paper compares and contrasts number of partners and condom use behaviour for female sex workers and a sample of women working in other economic activities, with both samples drawn from the large informal settlement of Kibera, Nairobi. Methods: As expected, univariate analysis revealed much higher numbers of overall sexual partners and higher levels of condom use among female sex workers compared to Kibera women in other occupations. An unexpected fi nding, however, was that female sex workers with a romantic partner had signifi cantly fewer sexual partners per unit time than female sex workers without such a partner. Results: This fi nding held for multivariate analysis, with negative binomial regression analyses showing that having a romantic partner was signifi cantly associated with reductions in total number of both sexual partners overall and with sexual partners who did not use condoms. In contrast, HIV status, education, number of immediate family members and levels of alcohol consumption were non-signifi cant factors for both regression analyses. Conclusions: Results suggest that female sex workers` romantic partners act as more than sources of possible HIV infection; rather, romantic partners appear to have an important positive impact on health. We discuss this fi nding in light of possible harm-reduction programmes focusing on female sex workers and their romantic partners.

Poster Session : PS 0454 ; Infectious Disease ; Risk Factors for Neonatal Conjunctivitis in Babies of HIV-1 Infected Mothers

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodefi ciency virus type 1 (HIV-1) infected mothers. Methods: This was a nested case-control study within a perinatal HIV-1 cohort. HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and shortcourse zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries. Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratifi ed for infant HIV-1 status. Results: Four hundred and fi fty-two infants were assessed and 101 (22.3%) had neonatal conjunctivitis during the fi rst month postpartum. In multivariate analyses using odds ratios (OR) and confi dence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis. Conclusions: Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.

Poster Session : PS 0437 ; Infectious Disease ; Predictors of Mortality in HIV-1 Infected Children on Antiretroviral Therapy in Kenya

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to defi ne correlates of mortality in order to improve outcome. Methods: HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models. Results: Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log10 copies/ml. Twenty children (13.4%) died at a median of 35 days post- HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in fi rst 4 months and 1.0 deaths/100 childyears after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weightfor- height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04). Conclusions: High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.

Poster Session : PS 0433 ; Infectious Disease ; Anal and Dry Sex in Commercial Sex Work, and Relation to Risk for Sexually Transmitted Infections and HIV

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To examine the practices of anal intercourse and dry sex within a cohort of female sex workers (FSWs) in Kenya, focusing on the prevalence and perceived risk of the practices, demographic and behavioural correlates, and association with sexually transmitted infections (STI). Methods: A survey was conducted among FSWs with 147 participants randomly sampled from an existing cohort of self identifi ed FSWs.Results: 40.8% of participants reported ever practising anal intercourse and 36.1% reported ever practising dry sex. Although the majority of women surveyed believed anal intercourse and dry sex to be high risk practices for HIV infection compared with vaginal sex, about one third of women reported never or rarely using condoms during anal intercourse, and about 20% never or rarely using condoms during dry sex. Reported consistent condom use was lower with both of these practices than with penile-vaginal intercourse. Anal intercourse was associated with experience of recent forced sexual intercourse, while dry sex was not. Anal intercourse was almost always initiated by clients, whereas dry sex was likely to be initiated by the women themselves. Sex workers reported charging higher fees for both practices than for vaginal intercourse. Both practices were associated with reported symptoms and diagnoses of STI. Conclusions: Both anal intercourse and dry sex were common in this sample, and although perceived as high risk practices, were not adequately protected with condom use. Education and other interventions regarding these high risk sexual behaviours need to be translated into safer practices, particularly consistent condom use, even in the face of fi nancial vulnerability.

Poster Session : PS 0372 ; Immunology ; HV-1-Specifi c Cytotoxic T Lymphocytes and Breast Milk HIV-1 Transmission

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Breast-feeding by infants exposed to human immunodefi ciency virus type 1 (HIV-1) provides an opportunity to assess the role played by repeated HIV-1 exposure in eliciting HIV-1-specifi c immunity and in defi ning whether immune responses correlate with protection from infection. Methods: Breast-feeding infants born to HIV-1-seropositive women were assessed for HLA-selected HIV-1 peptide-specifi c cytotoxic T lymphocyte interferon (IFN)-gamma responses by means of enzyme-linked immunospot (ELISpot) assays at 1, 3, 6, 9, and 12 months of age. Responses were deemed to be positive when they reached > or = 50 HIV-1-specifi c sfu/1 x 10(6) peripheral blood mononuclear cells (PBMCs) and were at least twice those of negative controls. Results: A total of 807 ELISpot assays were performed for 217 infants who remained uninfected with HIV-1 at approximately 12 months of age; 101 infants (47%) had at least 1 positive ELISpot result (median, 78-170 sfu/1 x 10(6) PBMCs). The prevalence and magnitude of responses increased with age (P = .01 and P = .007, respectively); the median log(10) value for HIV-1-specifi c IFN-gamma responses increased by 1.0 sfu/1 x 10(6) PBMCs/month (P<0.001) between 1 and 12 months of age. Of 141 HIV-1-uninfected infants with 1-month ELISpot results, 10 (7%) acquired HIV-1 infection (0/16 with positive vs. 10/125 [8%] with negative ELISpot results; P = .6). Higher values for log(10) HIV-1-specifi c spot-forming units at 1 month of age were associated with a decreased risk of HIV-1 infection, adjusted for maternal HIV-1 RNA level (adjusted hazard ratio, 0.09 [95% confi dence interval, 0.01-0.72]). Conclusions: Breast-feeding HIV-1-exposed uninfected infants frequently had HIV-1-specific IFN-gamma responses. Greater early HIV-1-specific IFN-gamma responses were associated with decreased HIV-1 acquisition.

Poster Session : PS 0432 ; Infectious Disease ; Predictors of Consistent Condom Use among Female Sex Workers (FSWs),

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: We evaluated predictors of consistent condom use among female sex workers (FSWs), a core group for controlling the spread of HIV. Methods: In an analysis of data collected in 2004-2005 from 140 Kenyan FSWs who completed questionnaires administered during a baseline study visit and three bimonthly follow-up visits, we used a case-crossover design to identify predictors of consistent condom use during all coital acts in the preceding 2 weeks, overall and by partner type. Results: Participants (n=140) completed the baseline visit and 390 bimonthly follow- up visits. Alcohol use during sex was negatively associated with consistent condom use with helping partners (defi ned as regular sex partners to whom the woman could go for help or support if needed) (adjusted odds ratio [AOR], 2.6, 95% confi - dence interval [CI] 1.0-6.5) but not associated with condom use with other partners. Coital frequency was associated with condom use with other partners only. Women who reported 1-5 (AOR 11.0, 95% CI 4.3-28.3) or 6-9 recent coital acts (AOR 3.8, 95% CI 1.7-8.8) with other partners were more likely to report consistent condom use with those partners than were women who reported =10 acts. Having a recent partner delay payment was inversely associated with consistent condom use with helping, other, or all partners. Conclusions: Correlates of consistent condom use differed by partner type. By using a case-crossover design, we were able to identify potentially modifi able factors associated with consistent condom use by FSWs who used condoms consistently with a given partner type during some periods but not others.

Poster Session : PS 0587 ; Psychiatry ; Factors Associated with Relapse and Remission of Alcohol Dependent Persons after Community Based Treatment

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: This study sought to determine the factors associated with remission and relapse in a group of alcohol dependent persons undergoing Community Based Detoxifi cation and Rehabilitation of alcohol dependent persons Methods: One hundred and eighty eight (188) persons with Alcohol Use Disorder Identi- fi cation Test (AUDIT) positive were subjected to outpatient detoxifi cation for 10 days using a pair of ampoules of high potency Vitamin B and C intravenously daily for 3 consecutive days, diazepam 5 mg and carbamazepine 200 mg for 5 and 10 consecutive nights respectively on an outpatient basis. The participants were visited twice a week (at home) by the community based health workers and reviewed once a week by the principal investigator and attended a bimonthly group therapy session conducted in groups of 20 s as part of the rehabilitation process. The groups were converted to self-help groups after 4 months to generate income for the participants Results: Factors signifi cantly associated with relapse to alcohol use included severity of alcohol use and craving for alcohol at intake and the age of onset of alcohol drinking. Further there was a statistically signifi cant predictive value in the mean score of alcohol re-lated problems in the community based group (health, social, fi nancial and legal). Conclusions: Identifying factors that are associated with relapse after alcohol dependence treatment is likely to improve the effectiveness of treatment and prevent relapse in persons at risk. Knowledge of factors associated with relapse and remission after treatment for alcohol dependence enables the clinician to offer better individualized treatment. It also enables the clinician to predict which patients are likely to relapse and therefore offer appropriate and effective treatment to prevent relapse.

Poster Session : PS 0406 ; Infectious Disease ; Antenatal HIV Testing

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL).Methods: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. Subjects: Women undergoing radiotherapy for inoperable cervical cancer. Results: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were signifi cant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and fi nancial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. Conclusions: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers.Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted.

Poster Session : PS 0405 ; Infectious Disease ; Prevalent Herpes Simplex Virus Type 2 Infection as Associated with Altered Vaginal Flora and an Increased Susceptibility to Multiple Sexually Transmitted Infections

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Prevalent herpes simplex virus type 2 (HSV-2) infection increases human immunodefi ciency virus acquisition. We hypothesized that HSV-2 infection might also predispose individuals to acquire other common sexually transmitted infections (STIs). Methods: We studied the association between prevalent HSV-2 infection and STI incidence in a prospective, randomized trial of periodic STI therapy among Kenyan female sex workers. Participants were screened monthly for infection with Neisseria gonorrhoeae and Chlamydia trachomatis, and at least every 6 months for bacterial vaginosis (BV) and infection with Treponema pallidum, Trichomonas vaginalis, and/or HSV-2. Results: Increased prevalence of HSV-2 infection and increased prevalence of BV were each associated with the other; the direction of causality could not be determined. After stratifying for sexual risk-taking, BV status, and antibiotic use, prevalent HSV-2 infection remained associated with an increased incidence of infection with N. gonorrhoeae (incidence rate ratio [IRR], 4.3 [95% confi dence interval {CI}, 1.5-12.2]), T. vaginalis (IRR, 2.3 [95% CI, 1.3-4.2]), and syphilis (IRR, 4.7 [95% CI, 1.1-19.9]). BV was associated with increased rates of infection with C. trachomatis (IRR, 2.1 [95% CI, 1.1- 3.8]) and T. vaginalis (IRR, 8.0 [95% CI, 3.2-19.8]). Conclusions: Increased prevalences of HSV-2 infection and BV were associated with each other and also associated with enhanced susceptibility to an overlapping spectrum of other STIs. Demonstration of causality will require clinical trials that suppress HSV-2 infection, BV, or both.

Poster Session : PS 0431 ; Infectious Disease ; Partner Characteristics Predicting HIV-1 Set Point in Sexually Acquired HIV-1 among African Seroconverters

( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Plasma HIV-1 RNA set point is an important predictor of HIV-1 disease progression. We hypothesized that inoculum size and HIV-1 exposure prior to HIV-1 transmission may modulate set point. We evaluated predictors of set point among 141 African HIV-1 seroconverters and their HIV-1-infected study partners. Methods: We compared characteristics of seroconverters and their HIV-1-infected partners and HIV-1 set point. Data were from a clinical trial of genital HSV-2 suppressionwith acyclovir to reduce HIV-1 transmission in HIV-1 serodiscordant couples with HIV-1 transmission linkage assigned through virus sequencing. Our analysis includes data from all transmissions including those with transmission linkage to the HIV-1-infected “source partner” and those that were not linked to their HIV-1-infected study partner Results: n multivariable analysis, higher plasma HIV-1 in source partners was associated with higher seroconverter set point ( + 0.44 log10 copies/ml per log(10) source partner plasma HIV-1, p < 0.001). In addition, bacterial vaginosis (BV) among female source partners near the time of infection was associated with higher set point in their male seroconverters ( + 0.49 log(10), p = 0.04). Source partner characteristics associated with lower set point included male circumcision ( - 0.63 log(10), p = 0.03) and assignment to acyclovir ( - 0.44 log10, p = 0.02). The proportion of variation in set point explained by plasma HIV-1 RNA of the source partner, after controlling for other factors, was 0.06. Source partner plasma HIV-1 level is the most signifi cant predictor of seroconverter set point, possibly refi ecting characteristics of the transmitted virus. Conclusions: Acyclovir use, BV among women source partners, and circumcision among male source partners may alter the set point by affecting transmitted virus inoculum in the source partners` genital compartment.