Limits...
Africa's 32 cents solution for HIV/AIDS.

Hotez PJ, Fenwick A, Kjetland EF - PLoS Negl Trop Dis (2009)

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

By preventing urogenital schistosomiasis in sexually active females through simple and low-cost methods, we have an innovative and timely opportunity to reduce and possibly interrupt HIV/AIDS transmission throughout many rural areas of sub-Saharan Africa... More than 90% of the world's 207 million cases of schistosomiasis occur in sub-Saharan Africa, making this condition (as well as hookworm infection) one of the most common neglected tropical diseases in the region ,... The pathognomonic lesions associated with S. haematobium infection in the female genitals are mucosal grainy sandy patches linked to egg granulomas, which are usually associated with mucosal bleeding (especially “contact bleeding” during pelvic examination or sexual intercourse) and abnormal blood vessels... The homogenous yellow sandy patches of FGS may mimic the sexually transmitted diseases (STDs) and have been found to be associated with a variety of important clinical manifestations including bleeding disorders, dyspareunia, pelvic and lower abdominal pain, vaginal discharge, pollakisuria, stress incontinence, and infertility ,,,... Regardless of the mechanism, it is important to establish whether anti-schistosomal treatment could represent an innovative HIV/AIDS prevention strategy... Towards this end, praziquantel is both a highly effective and low-cost anti-schistosomal therapy and a prophylactic agent against schistosomal morbidity in adults... Among women with FGS, praziquantel will result in parasitological cure and halt the appearance of new ova in the urine and presumably in the genital tract... However, while there are instances when treatment will also reverse some of the lower genital tract abnormalities associated with FGS, regrettably praziquantel anthelminthic therapy among adult women (with established genital schistosomiasis) does not alleviate genital lesions, contact bleeding, or vessel abnormalities... However, we also feel that the evidence for FGS promoting HIV transmission is sufficiently compelling that it would be unethical to withhold mass treatment for many years while awaiting the results of a prospective study that follows school-age girls as they become sexually active women (and exposed to HIV)... However, dually infected men have been hypothesized to increase the risk of HIV/AIDS transmission to women through higher HIV viral loads in seminal ejaculate –... By comparison, PEPFAR (the US President's Emergency Plan for AIDS Relief) is projected to spend $18.8 billion over the next 5 years (representing the largest international health initiative ever devoted to a single disease), including $1.34 billion annually in support of treatment programs and $601 million annually in support of treatment strategies... Therefore, periodic praziquantel administration would represent a very small add-on cost to the PEPFAR budget, and yet would have the dual benefits of making dramatic improvements in the reproductive health of women living in rural Africa, likely reducing HIV/AIDS transmission... At the minimum, we strongly advocate for the introduction of low-cost praziquantel MDA in the PEPFAR countries of Mozambique, Tanzania, and Zambia by using PEPFAR funds in support of SCI activities through a Global Network for NTDs –... This represents a $0.32 solution that could have enormous benefits for young African women and a huge potential beneficial impact on Africa's AIDS epidemic.

Show MeSH
Global Distribution of HIV/AIDS in Africa, Showing the HIV Prevalence (%) in Adults (15–49) in Africa, 2007.Reprinted with the permission of UNAIDS (from page 39 in [30], Figure 2.8).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2682705&req=5

pntd-0000430-g002: Global Distribution of HIV/AIDS in Africa, Showing the HIV Prevalence (%) in Adults (15–49) in Africa, 2007.Reprinted with the permission of UNAIDS (from page 39 in [30], Figure 2.8).

Mentions: Our hypothesis is that treatment of younger females at risk of schistosomiasis is therefore critical, and that praziquantel treatment of young school-age girls will prevent the development of FGS and therefore represent an innovative AIDS prevention strategy in areas of HIV and S. haematobium transmission. In a cross-sectional study in northern Zimbabwe, women who report having received praziquantel treatment before the age of 20 exhibited an absence of sandy patches and contact bleeding that was independent of adult waterbody contact [27]. Based on this study, we believe there is an urgent need to demonstrate the impact of praziquantel on HIV transmission in prospective studies among school-age girls living in HIV/AIDS and schistosomiasis co-endemic areas, such as in the southeastern countries of Malawi, Mozambique, Tanzania, and Zimbabwe, areas which exhibit high prevalences of both S. haematobium and HIV infections (Figures 1 and 2). We further support efforts to seek additional funds in order to investigate this innovative HIV/AIDS control tool. There is also some evidence that Schistosoma mansoni infection could result in FGS, although at a lower rate than S. haematobium infection [28]; this also warrants further study, particularly given that vaccines against both S. haematobium and S. mansoni infection are under development [2],[29].


Africa's 32 cents solution for HIV/AIDS.

Hotez PJ, Fenwick A, Kjetland EF - PLoS Negl Trop Dis (2009)

Global Distribution of HIV/AIDS in Africa, Showing the HIV Prevalence (%) in Adults (15–49) in Africa, 2007.Reprinted with the permission of UNAIDS (from page 39 in [30], Figure 2.8).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2682705&req=5

pntd-0000430-g002: Global Distribution of HIV/AIDS in Africa, Showing the HIV Prevalence (%) in Adults (15–49) in Africa, 2007.Reprinted with the permission of UNAIDS (from page 39 in [30], Figure 2.8).
Mentions: Our hypothesis is that treatment of younger females at risk of schistosomiasis is therefore critical, and that praziquantel treatment of young school-age girls will prevent the development of FGS and therefore represent an innovative AIDS prevention strategy in areas of HIV and S. haematobium transmission. In a cross-sectional study in northern Zimbabwe, women who report having received praziquantel treatment before the age of 20 exhibited an absence of sandy patches and contact bleeding that was independent of adult waterbody contact [27]. Based on this study, we believe there is an urgent need to demonstrate the impact of praziquantel on HIV transmission in prospective studies among school-age girls living in HIV/AIDS and schistosomiasis co-endemic areas, such as in the southeastern countries of Malawi, Mozambique, Tanzania, and Zimbabwe, areas which exhibit high prevalences of both S. haematobium and HIV infections (Figures 1 and 2). We further support efforts to seek additional funds in order to investigate this innovative HIV/AIDS control tool. There is also some evidence that Schistosoma mansoni infection could result in FGS, although at a lower rate than S. haematobium infection [28]; this also warrants further study, particularly given that vaccines against both S. haematobium and S. mansoni infection are under development [2],[29].

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

By preventing urogenital schistosomiasis in sexually active females through simple and low-cost methods, we have an innovative and timely opportunity to reduce and possibly interrupt HIV/AIDS transmission throughout many rural areas of sub-Saharan Africa... More than 90% of the world's 207 million cases of schistosomiasis occur in sub-Saharan Africa, making this condition (as well as hookworm infection) one of the most common neglected tropical diseases in the region ,... The pathognomonic lesions associated with S. haematobium infection in the female genitals are mucosal grainy sandy patches linked to egg granulomas, which are usually associated with mucosal bleeding (especially “contact bleeding” during pelvic examination or sexual intercourse) and abnormal blood vessels... The homogenous yellow sandy patches of FGS may mimic the sexually transmitted diseases (STDs) and have been found to be associated with a variety of important clinical manifestations including bleeding disorders, dyspareunia, pelvic and lower abdominal pain, vaginal discharge, pollakisuria, stress incontinence, and infertility ,,,... Regardless of the mechanism, it is important to establish whether anti-schistosomal treatment could represent an innovative HIV/AIDS prevention strategy... Towards this end, praziquantel is both a highly effective and low-cost anti-schistosomal therapy and a prophylactic agent against schistosomal morbidity in adults... Among women with FGS, praziquantel will result in parasitological cure and halt the appearance of new ova in the urine and presumably in the genital tract... However, while there are instances when treatment will also reverse some of the lower genital tract abnormalities associated with FGS, regrettably praziquantel anthelminthic therapy among adult women (with established genital schistosomiasis) does not alleviate genital lesions, contact bleeding, or vessel abnormalities... However, we also feel that the evidence for FGS promoting HIV transmission is sufficiently compelling that it would be unethical to withhold mass treatment for many years while awaiting the results of a prospective study that follows school-age girls as they become sexually active women (and exposed to HIV)... However, dually infected men have been hypothesized to increase the risk of HIV/AIDS transmission to women through higher HIV viral loads in seminal ejaculate –... By comparison, PEPFAR (the US President's Emergency Plan for AIDS Relief) is projected to spend $18.8 billion over the next 5 years (representing the largest international health initiative ever devoted to a single disease), including $1.34 billion annually in support of treatment programs and $601 million annually in support of treatment strategies... Therefore, periodic praziquantel administration would represent a very small add-on cost to the PEPFAR budget, and yet would have the dual benefits of making dramatic improvements in the reproductive health of women living in rural Africa, likely reducing HIV/AIDS transmission... At the minimum, we strongly advocate for the introduction of low-cost praziquantel MDA in the PEPFAR countries of Mozambique, Tanzania, and Zambia by using PEPFAR funds in support of SCI activities through a Global Network for NTDs –... This represents a $0.32 solution that could have enormous benefits for young African women and a huge potential beneficial impact on Africa's AIDS epidemic.

Show MeSH