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1.  Effects of maternal and infant co-infections, and of maternal immunisation, on the infant response to BCG and tetanus immunisation 
Vaccine  2010;29(2-2):247-255.
Some vaccines show poor efficacy in tropical countries. Within a birth cohort in Uganda, we investigated factors that might influence responses to BCG and tetanus immunisation. Whole blood assay responses to crude culture filtrate proteins of Mycobacterium tuberculosis (cCFP)) and tetanus toxoid (TT) were examined among 1506 and 1433 one-year-olds, respectively. Maternal Mansonella perstans infection was associated with higher interleukin (IL)-10 responses to both immunogens but no reduction in gamma interferon (IFN-γ), IL-5 and IL-13 responses; other maternal helminth infections showed little effect. Tetanus immunisation during pregnancy was associated with higher infant responses to TT; maternal BCG scar (from past immunisation) with lower infant IL-5 and IL-13 responses to cCFP. IFN-γ, IL-5 and IL-13 to TT were reduced in HIV-exposed-uninfected infants; infant malaria and HIV were associated with lower IFN-γ, IL-5 and IL-13 responses to both immunogens. We conclude that maternal helminth infections are unlikely to explain poor vaccine efficacy in the tropics. Effects of maternal immunisation on infant responses to vaccines should be explored. Prevention of infant malaria and HIV could contribute to effectiveness of immunisation programmes.
PMCID: PMC3021124  PMID: 21040693
BCG; Tetanus; Immunisation
2.  Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study 
BMJ : British Medical Journal  2002;324(7331):193-197.
To estimate the rate of progression from seroconversion to symptomatic disease in adults infected with HIV-1, and to establish whether the background level of signs and symptoms commonly associated with HIV-1 in uninfected controls are likely to affect progression rates.
Longitudinal, prospective cohort study of people infected with HIV-1 and randomly selected subjects negative for HIV-1 antibodies identified during population studies.
Study clinic with basic medical care in rural Uganda.
275 patients infected with HIV-1 (107 prevalent cases and 168 incident cases) and 246 controls negative for HIV-1 antibodies.
Main outcome measures
Signs and symptoms of HIV disease, as determined by stages 2 and 3 of the World Health Organization clinical staging system.
The median time from seroconversion to WHO stage 2 was 25.4 months and to stage 3 was 45.5 months. 43% of the participants infected with HIV-1 had signs or symptoms by two years after seroconversion. The most common clinical conditions used to define progression of disease were weight loss, mucocutaneous manifestations, bacterial infections, chronic fever, and chronic diarrhoea. Although the rates of these conditions (apart from minor weight loss) were significantly higher in the participants infected with HIV-1, they were also relatively frequent in the control group. Herpes zoster, oral candidiasis, and pulmonary tuberculosis were not common events in the control group and therefore were more indicative of infection with HIV-1.
Disease progression associated with infection with HIV-1 seems to be rapid in rural Uganda. This is most likely due to the high prevalence of conditions in the general population that could be taken as symptoms and signs of infection with HIV-1.
What is already known on this topicThe few studies that have reported time from seroconversion to HIV-1 symptomatic disease in poor countries suggest that this interval is shorter than in rich countriesWhat this study addsProgression from seroconversion to symptomatic disease seems to be rapid in rural AfricaThe apparent rapid disease progression in rural Africa is most likely to be due to the high prevalence of what could be taken as symptoms and signs of HIV-1 in the general population
PMCID: PMC64788  PMID: 11809639

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