BackgroundData on long-term outcomes of patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are few. We describe outcomes of patients commenced on ART at Newlands Clinic between 2004 and 2006 after ≥10 years of comprehensive care including, psychosocial, adherence and food support.MethodsIn this retrospective cohort study, patient data from an electronic medical record collected during routine care were analysed. We describe baseline characteristics, virological and clinical outcomes, attrition rates, and treatment adverse effects until November 2016. We defined virological suppression as viral load <50 copies/ml and virological failure as >1000 copies/ml after ≥6 months of ART.ResultsWe analysed data for 605 patients (67% female) who commenced ART, and were followed-up for 5819 person-years (median: 10.7 years, IQR: 10.1–11.4). Median age at ART initiation was 34 years (IQR: 17–42). Pre-ART, 129 (21.3%) patients had history of pulmonary tuberculosis (PTB). In care, 66 (11%) developed PTB, and 24 (4%) developed extrapulmonary tuberculosis. 385 (63.6%) patients experienced ≥1 adverse event, the most frequent being stavudine-induced peripheral neuropathy (n = 252, 41.7%). At database closure on 14 November 2016, 474 (78.3%) patients were still in care, 428 (90.3%) being virologically suppressed, and 21 (4.4%) failing. While 483 (79.8%) remained on first line, 122 (20.2%) were switched to second line ART. Fifty-nine patients (9.8%) were transferred to other ART facilities, 45 (7.4%) were lost to follow-up, 25 (4.1%) died, and two stopped ART.ConclusionComprehensive HIV care can result in low mortality, high retention in care and virologic suppression rates in resource limited settings.

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Treatment with single doses of antibiotics of uncomplicated urinary tract infections in women is a well-established therapeutic regimen (1,4,12,15,20). Therapeutic failures following a single-dose treatment appear to predict complicating factors such as silent pyelonephritis (14), morphologic alterations, dynamic disturbances, or microbial resistance to antibiotics (6,8,11,13).Ciprofloxacin, a new'quinolone drug which can be administered both orally and intravenously, has good antimicrobial activity against microorganisms frequently found in urinary tract infections. The aim of the present study was to evaluate the efficacy of a single dose of ciprofloxacin in the treatment of uncomplicated'urinary tract infection. In addition, two oral doses, 250 and 100 mg, were compared to estimate clinical and bacteriological efficacy at the lower-dosage range.Women 16 years or older attending our outpatient clinic were enrolled in the study if they presented with acute dysuria and frequent micturition of <72 h in' duration. Admission criteria included bacteriuria (>102 CFPU/ml) and pyuria (>10 leukocytes per mm3). Exclusion criteria were pregnancy, fever of >38°C, serum creatinine of >115 pumol/liter, and a history of antecedent complicated urinary tract infection (e.g., due to obstruction in the u4nary tract).Uncomplicated recurrent urinary tract infections did not lead to exclusion. A total blood count, erythrocyte sedimentation rate, serum creatinine, alkaline phosphatase, and glutamate pyruvate transaminase were determined at presentation.Midstream urine was collected after individual instruction of the patient and was cultivated quantitatively on human blood and MacConkey agar plates. Uropathogenic microorganisms were differentiated according to standard methods, and Staphylococcus saprophyticus was identified by the novobiocin method (5). A routine sensitivity test by photometric measurement of the optical density (MS-2 automated antimicrobial susceptibility testing system; Abbott Laboratories, Chicago, Ill.), as well as determinations of MICs by a micromethod (16) in Mueller-Hinton broth and a disk test on Mueller-Hinton agar for ciprofloxacin, was performed for all isolates (2). Patients received either 100 or 250 mg of ciprofloxacin orally at presentation, before any laJoratory values were available.A total of 40 women with a median age of 25.0 years (range, 18 to 61 years) entered the study, 2 of whom had to be excluded because initial culture-s were inconclusive * Corresponding author.354

An increase in total urinary neopterin was observed in 12 of 13 patients with acquired immunodeficiency syndrome (AIDS), seven of 13 patients with lymphadenopathy, one of six healthy homosexual males, seven of ten adult patients with staphylococcal pneumonia, 11 of 12 children with viral infections, four of seven children with bacterial infections, and 12 of 13 children with various immune defects. Extremely high values of total urinary neopterin and monapterin were observed in severely ill patients with AIDS and those with familial hemophagocytic lymphohistiocytosis. Neopterin excretion was normal in two AIDS patients with Kaposi's sarcoma, but without opportunistic infections at that time. On reexamination of one of these patients later on, elevated neopterin values were noted. Parallel increases in neopterin and monapterin were found, whereas biopterin was usually normal. The increase in total neopterin was mainly due to 7,8-dihydroneopterin and was accompanied by an increase in 3'-hydroxysepiapterin. Increased neopterin in urine is assumed to reflect the increase in GTP pool and GTP cyclohydrolase I activity as observed in stimulated monocytes. Thus, neopterin, as a measure of the activation of the nonspecific cellular immune system, may be used diagnostically to detect allograft rejection after transplantations and to follow-up HTLV-III positive patients.

At our AIDS outpatient clinic we presently care for more than 1,200 HIV-infected patients. All physicians in this unit have participated for 1 year in a case work group supervised by a liaison psychiatrist. The doctor-patient relationship, the assessment in the case work group and the ensuing influence on perception and behavior are demonstrated by 3 cases. Different issues challenge the doctor-patient relationship: the serious prognosis of predominantly young AIDS patients; isolation and stigmatization of patients; fear of contagion, and questions of confidentiality regarding contact tracing. Reflection upon the doctor-patient relationship improves communication skills and increases empathy towards AIDS patients.