HIV-1 prevalence is rising in this cohort. Incidence is stabilizing, and shows signs of increasing among some subgroups. The extent to which changing sexual behaviour has played a role in these epidemiological trends is unclear, but it is likely to have contributed. To solidify the success that Uganda had throughout the 1990s in controlling the HIV epidemic, the efforts in HIV prevention need to be re-strengthened, using all strategies known.

Summary Objectives  To determine the prevalence and incidence of anaemia in HIV‐positive and negative individuals; to identify risk factors for anaemia, prior to the introduction of HAART; and to determine the validity of the clinical diagnosis of anaemia. Methods  Between 1990 and 2003, we followed a rural population based cohort of HIV‐infected and uninfected participants. Prevalence and incidence of anaemia were determined clinically and by laboratory measurements. The sensitivity, specificity and predictive values of clinical diagnosis were calculated. Results  The prevalence of anaemia at enrolment was 18.9% among HIV‐positive and 12.9% among HIV‐negative participants (P = 0.065). Incidence of anaemia increased with HIV disease progression, from 103 per 1000 person‐years of observation among those with CD4 counts >500 to 289 per 1000 person‐years of observation among those with CD4 counts <200. Compared to laboratory diagnosis, the clinical diagnosis of anaemia had a sensitivity of 17.8%, specificity of 96.8%, a positive predictive value of 50.6% and a negative predictive value of 86.4%. Being female, low CD4 cell counts, HIV‐positive, wasting syndrome, WHO stage 3 or 4, malaria, fever, pneumonia and oral candidiasis were associated with prevalent anaemia. Conclusions  Anaemia prevalence and incidence were higher among HIV‐positive than negative participants. Compared to laboratory diagnosis, clinical detection of anaemia had a low sensitivity. Clinicians working in settings with limited laboratory support must be conscious of the risk of anaemia when managing HIV/AIDS patients, particularly when using antiretroviral drugs which by themselves may cause anaemia as a side effect. We recommend that haemoglobin should be measured before starting ART and monthly for the first three months.

This study investigated HIV seroprevalence and it's correlates among patients with first-time psychiatric admissions to two national referral hospitals in urban Kampala, Uganda. A structured standardised evaluation was used to assess patients for: Diagnostic and Statistical Manual IV psychiatric diagnosis, socio-demographics, sexual behaviour and HIV status (for those HIV-positive, CDC classification and CD4 cell counts). The HIV-1 seroprevalence was 18.4% (95% CI, 13.8-23.0%). Factors that were independently associated with HIV-1 seropositivity were female gender and older age (41+years) and after adjusting for sex and age group, the nature of the current episode (highest among those with first episode of mental illness) and psychiatric diagnoses (highest in the organic affective disorders and delirium, lowest in those with bipolar affective disorder and psychotic syndromes). These results demonstrate that the prevalence of HIV is high among patients with severe mental illness in Africa and that HIV/AIDS adds to the burden of mental illness in high HIV prevalence countries in sub-Saharan Africa. Both HIV care programmes and psychiatric care clinics should be made aware of the frequent association of HIV infection and mental illness, and adopt important diagnostic and care elements of these complementary disciplines in the training and the day-to-day work of clinicians, nurses and counsellors.

Abstractobjectives Before antiretroviral therapy (ART) introduction, pregnancy was associated with a sustained drop in CD4 cell count in HIV-infected women. We examined the effects of pregnancy on immunological and virological ART outcomes.methods Between January 2004 and March 2009, we studied HIV-infected women receiving ART in a prospective open cohort study in rural Uganda. We used random effects regression models to compare the CD4 counts of women who became pregnant and those who did not, and among the pregnant women before and after pregnancy. CD4 count and proportions with detectable viral load ( ‡400 copies ⁄ ml) were compared between the two groups using the Mann-Whitney rank sum test and logistic regression respectively.results Of 88 women aged 20-40 years receiving ART, 23 became pregnant. At ART initiation, there were no significant differences between those who became pregnant and those who did not in clinical, immunological and virological parameters. Among women who became pregnant, CD4 cell count increased before pregnancy (average 75.9 cells ⁄ mm 3 per year), declined during pregnancy (average 106.0) but rose again in the first year after delivery (average 88.6). Among women who did not become pregnant, the average CD4 cell count rise per year for the first 3 years was 88.5. There was no significant difference in the proportions of women with detectable viral load at last clinic visit among those who became pregnant (8.7%) and those who did not (16.1%), P = 0.499.conclusion Pregnancy had no lasting effect on the immunological and virological outcomes of HIV-infected women on ART.

Differences between HIV mortality in different populations and age groups are not explained by differences in background mortality, although this does appear to contribute to the excess at older ages. In the absence of data from uninfected individuals in the same population, model life tables can be used to calculate background rates.