Both leprosy and tuberculosis were prevalent in Europe during the first millennium but thereafter leprosy declined. It is not known why this occurred, but one suggestion is that cross-immunity protected tuberculosis patients from leprosy. To investigate any relationship between the two diseases, selected archaeological samples, dating from the Roman period to the thirteenth century, were examined for both Mycobacterium leprae and Mycobacterium tuberculosis DNA, using PCR. The work was carried out and verified in geographically separate and independent laboratories. Several specimens with palaeopathological signs of leprosy were found to contain DNA from both pathogens, indicating that these diseases coexisted in the past. We suggest that the immunological changes found in multi-bacillary leprosy, in association with the socio-economic impact on those suffering from the disease, led to increased mortality from tuberculosis and therefore to the historical decline in leprosy.

CD4 T cell apoptosis by the intrinsic pathway represents the determinant mechanism of the unsatisfactory immune recovery and should be targeted to manage therapy for discordant patients. The predictive value of low nadir CD4 T cell count for a poor immune recovery led us to consider starting antiretroviral therapy earlier. No differences were observed among antiretrovirals in terms of immune recovery.

Mild and clinically tolerable neuropsychiatric disorders may persist in patients after a mean of 2 years using an efavirenz-based approach. Quality of life and psychologic status remained good in both study groups. Interventions to enhance long-term adherence should be applied in clinical practice.

Cribra orbitalia (CO), an osseous sign of anemic stress, occurs in 67% (n = 296) of the pre-Roman (n = 153) and Roman (n = 143) period crania from the Dakhleh Oasis, Egypt. CO is primarily a childhood condition in these samples, and its prevalence is significantly higher in virtually all cohorts in the pre-Roman group, including among females, who display higher rates of active lesions. This temporal trend suggests that the underlying causative factors (i.e., synergism between disease and nutrition) were less pervasive in the Roman period. In both population samples, anemic stress develops in some perinates prior to the expected minimum age for the development of iron deficiency anemia. This suggests additional causes of anemic stress in the Dakhleh population. A strong candidate is folic acid deficiency and its concomitant, megaloblastic anemia, which results from weaning of infants on goat's milk, a known practice in ancient Egypt. The putative incorporation of other food items in the weanling diet, particularly honey, a confirmed source of C. botulinum, represents yet another retrospective data source to help understand the epidemiological profile of cribra orbitalia in this population. Comparative data from other Egyptian populations, though limited, show similar patterns, however, they display a lower prevalence than the data from Dakhleh.

Much can be learned about the religious ideology and mortuary patterns as well as the demographic and health profiles of a population from archaeological human fetal skeletons. Fetal skeletons are rare, however, largely due to poor preservation and recovery, misidentification, or non-inclusion in general burial populations. We present an analysis of 82 fetal/ perinatal skeletons recovered from Kellis 2, a Roman Period cemetery dated to the third and fourth centuries AD, located in the Dakhleh Oasis, Egypt. Most of the fetal remains were individually wrapped in linen and all were buried among the general cemetery population in a supine, east-west orientation with the head facing to the west. Gestational age estimates are calculated from diaphysis lengths using published regression and Bayesian methods. The overall similarity between the fetal age distributions calculated from the regression and Bayesian methods suggests that the correlation between diaphysis length and gestational age is typically strong enough to avoid the 'regression' problem of having the age structure of reference samples adversely affecting the age distribution of target samples. The inherent bias of the regression methods, however, is primarily reflected in the gestational age categories between 36 and 42 weeks corresponding with the expected increase in growth variation during the late third trimester. The results suggest that the fetal age distribution at Kellis 2 does not differ from the natural expected mortality distribution. Therefore, practices such as infanticide can be ruled out as having a significant effect on the observed mortality distribution. Moreover, the Kellis 2 sample is well represented in each gestational age category, suggesting that all premature stillbirths and neonatal deaths received similar burial rites. The age distribution of the Kellis 2 fetal remains suggests that emerging Christian concepts, such as the 'soul' and the 'afterlife', were being applied to everyone including fetuses of all gestational ages.