In rare cases, immune system fails despite HIV suppression

Antiretroviral therapy (ART) is usually very effective at suppressing HIV in the body, allowing a person’s immune system to recover by preventing the virus from destroying CD4+ T cells(link is external).


Colorized scanning electron micrograph of a T lymphocyte.NIAID

Scientists have now identified a rare, paradoxical response to ART known as extreme immune decline, or EXID. Five individuals evaluated at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, experienced a significant decline in CD4+ T cell levels despite suppression of HIV below detectable levels for more than three years, according to a report published online today in JCI Insight.  

The research team was led by Irini Sereti, M.D., chief of the HIV Pathogenesis Section in NIAID’s Laboratory of Immunoregulation, and Andrea Lisco, M.D., Ph.D.

The NIAID researchers found that the immune systems of people with EXID fared even worse than those of another subset of individuals defined as immunological-non-responders, or INRs, who respond inadequately to ART.  INR participants consistently taking ART for four years had CD4+ T cell counts that increased on average by 193 cells per microliter (µL) of blood.  Participants who responded normally to ART increased their CD4+ T cell count by more than twice that amount. In contrast, the five participants with EXID experienced an average decline of 157 CD4+ T cells/µL while consistently maintaining viral suppression on ART.

According to the NIAID team, there seems to be no single cause of EXID among the five individuals studied. Their analyses revealed that genes influencing immune cell activity and autoimmunity—the immune system attacking a body’s own healthy tissue—may play a role. Specifically, two of the individuals with EXID produced antibodies that attacked their own T cells, while two others had overactive cellular immune responses that lead to increased inflammation. All five participants with EXID had HIV strains other than clade B HIV (the most common strain circulating in North America and Europe), indicating that certain combinations of an individual’s genes and the HIV strain may be associated with EXID. While EXID is likely an extremely rare response to ART, the researchers indicate that studying this phenomenon may further illuminate CD4+ T cell reconstitution and inflammation in HIV disease and suggest possible treatment strategies for INRs and individuals with EXID.

Advertisements

WHO releases first guideline on digital health interventions

WHO on Wednesday released new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services.

“Harnessing the power of digital technologies is essential for achieving universal health coverage,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”

Over the past two years, WHO systematically reviewed evidence on digital technologies and consulted with experts from around the world to produce recommendations on some key ways such tools may be used for maximum impact on health systems and people’s health.

One digital intervention already having positive effects in some areas is sending reminders to pregnant women to attend antenatal care appointments and having children return for vaccinations. Other digital approaches reviewed include decision-support tools to guide health workers as they provide care; and enabling individuals and health workers to communicate and consult on health issues from across different locations.

“The use of digital technologies offers new opportunities to improve people’s health,” says Dr Soumya Swaminathan, Chief Scientist at WHO. “But the evidence also highlights challenges in the impact of some interventions.”

She adds: “If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate long-term improvements over the traditional ways of delivering health services.”

For example, the guideline points to the potential to improve stock management. Digital technologies enable health workers to communicate more efficiently on the status of commodity stocks and gaps. However, notification alone is not enough to improve commodity management; health systems also must respond and take action in a timely manner for replenishing needed commodities. 

“Digital interventions, depend heavily on the context and ensuring appropriate design,” warns Dr Garrett Mehl, WHO scientist in digital innovations and research. “This includes structural issues in the settings where they are being used, available infrastructure, the health needs they are trying to address, and the ease of use of the technology itself.”

The guideline demonstrates that health systems need to respond to the increased visibility and availability of information. People also must be assured that their own data is safe and that they are not being put at risk because they have accessed information on sensitive health topics, such as sexual and reproductive health issues.

Health workers need adequate training to boost their motivation to transition to this new way of working and need to use the technology easily. The guideline stresses the importance of providing supportive environments for training, dealing with unstable infrastructure, as well as policies to protect privacy of individuals, and governance and coordination to ensure these tools are not fragmented across the health system.

The guideline encourages policy-makers and implementers to review and adapt to these conditions if they want digital tools to drive tangible changes and provides guidance on taking privacy considerations on access to patient data.

“Digital health is not a silver bullet,” says Bernardo Mariano, WHO’s Chief Information Officer. “WHO is working to make sure it’s used as effectively as possible. This means ensuring that it adds value to the health workers and individuals using these technologies, takes into account the infrastructural limitations, and that there is proper coordination.”

The guideline also makes recommendations about telemedicine, which allows people living in remote locations to obtain health services by using mobile phones, web portals, or other digital tools. WHO points out that this is a valuable complement to face-to-face-interactions, but it cannot replace them entirely. It is also important that consultations are conducted by qualified health workers and that the privacy of individuals’ health information is maintained.

The guideline emphasizes the importance of reaching vulnerable populations, and ensuring that digital health does not endanger them in any way.

AfDB organizes roadshow to whet investor interest ahead of Africa Investment Forum 2019

Department and city businesses

The African Development Bank has organised a roadshow to drum up support from Angolan investors ahead of the second edition of the Africa Investment Forum (AIF) in November 2019.

The Angola Country Office of the African Development Bank Group, in collaboration with Executive Director of the Export Promotion and Private Investment Agency (AIPEX) and the Ministry of Economy and Planning (MEP), organized the Luanda roadshow, held on 11 April 2019. About 170 participants from the public and private sector attended.

The Bank’s maiden investment forum held in November 2018 saw an unprecedented gathering of world-class investors, meeting with the aim of bridging the continent’s growing infrastructure investment gap. The event exceeded all expectations with projects worth over US$38.7 billion securing investment interest in 72 hours.

 Joseph Ribeiro, Bank Country manager for Angola, Ezekiel Odiogo, the Africa Investment Forum Department’s Head of Private Sector Investment Operations, Neima Ferreira, Senior Investment Officer of the Africa Investment Forum and Elsa Nabenge, consultant economist and local private sector focal point, represented the Bank team at the event.

During the event, Marcelino Pinto, MEP Director for Economy, Competitiveness and Innovation and José Chinjamba, AIPEX Executive Director, showcased Angola’s economic reform plans over the last 15 months, aimed at attracting foreign investments and creating an enabling environment for businesses to thrive.

They highlighted the fact that the Angolan authorities had established the Domestic Production, Export Diversification, and Import Substitution programme (PRODESI), as part of its agenda to achieve accelerated private sector-led economic diversification.  

 “The implemented and ongoing set of reforms, as well as the instruments of credit facilitation, attest to the Government’s willingness to support private activities in order to take advantage of opportunities offered by platforms such as the Africa Investment Forum,” Pinto told participants, made up of representatives of commercial banks, development financial institutions, transaction advisors and investment fund managers.

Also addressing the gathering, Ribeiro said Angola needed substantial investments in strategic sectors for diversified economic development, in order to enhance its position as Sub-Saharan Africa’s third largest economy.

“To this end, it is not only fundamental, but necessary, to join efforts to overcome the challenges that are posed to the development of the private sector in Angola,” he added.

Representatives of chambers of commerce in Angola, start-ups and accelerators, project sponsors, promoters and developers also attended the event.

To date, 26 projects have been identified in Angola, covering various sectors including infrastructure, agribusiness, waste management and recycling, renewable energy and ICT. The projects are currently being screened through ongoing B2B sessions.   

The Angola roadshow is one of several other events to be convened in the Southern Africa region by the Bank’s Africa Investment Forum team in preparation for the 2019 Forum, which will take place from 13-15 November 2019, at the Sandton Convention Centre in Johannesburg.

Want to learn a new skill? Take some short breaks

NIH study suggests our brains may use short rest periods to strengthen memories.

In a study of healthy volunteers, National Institutes of Health researchers found that our brains may solidify the memories of new skills we just practiced a few seconds earlier by taking a short rest. The results highlight the critically important role rest may play in learning.

In a study of healthy volunteers, NIH researchers found that taking short breaks, early and often, may help our brains learn new skills.Cohen lab, NIH/NINDS

“Everyone thinks you need to ‘practice, practice, practice’ when learning something new. Instead, we found that resting, early and often, may be just as critical to learning as practice,” said Leonardo G. Cohen, M.D., Ph.D., senior investigator at NIH’s National Institute of Neurological Disorders and Stroke and a senior author of the paper published in the journal Current Biology. “Our ultimate hope is that the results of our experiments will help patients recover from the paralyzing effects caused by strokes and other neurological injuries by informing the strategies they use to ‘relearn’ lost skills.”

The study was led by Marlene Bönstrup, M.D., a postdoctoral fellow in Dr. Cohen’s lab. Like many scientists, she held the general belief that our brains needed long periods of rest, such as a good night’s sleep, to strengthen the memories formed while practicing a newly learned skill. But after looking at brain waves recorded from healthy volunteers in learning and memory experiments at the NIH Clinical Center, she started to question the idea.

The waves were recorded from right-handed volunteers with a highly sensitive scanning technique called magnetoencephalography. The subjects sat in a chair facing a computer screen and under a long cone-shaped brain scanning cap. The experiment began when they were shown a series of numbers on a screen and asked to type the numbers as many times as possible with their left hands for 10 seconds; take a 10 second break; and then repeat this trial cycle of alternating practice and rest 35 more times. This strategy is typically used to reduce any complications that could arise from fatigue or other factors.

As expected, the volunteers’ speed at which they correctly typed the numbers improved dramatically during the first few trials and then leveled off around the 11th cycle. When Dr. Bönstrup looked at the volunteers’ brain waves she observed something interesting.

“I noticed that participants’ brain waves seemed to change much more during the rest periods than during the typing sessions,” said Dr. Bönstrup. “This gave me the idea to look much more closely for when learning was actually happening. Was it during practice or rest?”

By reanalyzing the data, she and her colleagues made two key findings. First, they found that the volunteers’ performance improved primarily during the short rests, and not during typing. The improvements made during the rest periods added up to the overall gains the volunteers made that day. Moreover, these gains were much greater than the ones seen after the volunteers returned the next day to try again, suggesting that the early breaks played as critical a role in learning as the practicing itself.

Second, by looking at the brain waves, Dr. Bönstrup found activity patterns that suggested the volunteers’ brains were consolidating, or solidifying, memories during the rest periods. Specifically, they found that the changes in the size of brain waves, called beta rhythms, correlated with the improvements the volunteers made during the rests.

Further analysis suggested that the changes in beta oscillations primarily happened in the right hemispheres of the volunteers’ brains and along neural networks connecting the frontal and parietal lobes that are known to help control the planning of movements. These changes only happened during the breaks and were the only brain wave patterns that correlated with performance. 

“Our results suggest that it may be important to optimize the timing and configuration of rest intervals when implementing rehabilitative treatments in stroke patients or when learning to play the piano in normal volunteers,” said Dr. Cohen. “Whether these results apply to other forms of learning and memory formation remains an open question.”

Dr. Cohen’s team plans to explore, in greater detail, the role of these early resting periods in learning and memory.

Local ophthalmologists are learning to provide specialized care to Ebola survivors in the DRC

Knowledge gained following the 2014–16 West Africa Ebola outbreak identified a number of challenges survivors face, including reduced or blurred vision stemming from inflammation of their eyes. About 20% of survivors from that outbreak had some form of eye problem.

Muhindo, a young Ebola survior, has his eyes tested by Dr Steven Yeh
WHO/J. D. Kannah

By identifying and treating these problems early, serious consequences, including blindness, can be averted. With the Ministry of Health of the Democratic Republic of the Congo (DRC), the World Health Organization recently organized an eye clinic to check on the eye health of survivors of the current Ebola outbreak.

The clinic was held in Beni, DRC, one of the affected areas, from 25 March to 1 April. In addition, an eye clinic in Butembo, another affected area, was equipped so that they can provide this specialized care to survivors there. This is the first time in an Ebola outbreak that follow-up for eye care has happened so soon after survivors have been released from care.

Several survivors also helped with the planning and administration of the clinic. Partners in this project include Emory University, which deployed two ophthalmologists, and University of North Carolina which deployed one ophthalmologist to the project via the Global Outbreak Alert and Response Network, which is hosted by WHO.


2015 Publication of The Specimen Newspaper in Freetown, Sierra Leone

Editor’s note: Cases of poor eye sight and heart diseases, among others, were reported by some Ebola survivors in Sierra Leone. The Specimen Newspaper reported the stories to alert the authority and stakeholders about the health challenges of the survivors in post Ebola period.

This medium’s editorial policy is centered on public health issues and development and is open to ideas and publications to be published for better information dissemination. With information the readers would be able to take informed health decisions.

Pope Francis Admonishes South Sudan leaders to ‘Stay in Peace’

On Thursday in the Vatican in an unprecedented gesture Pope Francis kisses the feet of South Sudan President Salva Kiir as he prays and begs for peace in that country. 

The pope begged the leaders to give peace a chance. At right is Vice President Riek Machar. (CNS photo/Vatican Media via Reuters)

“I’m asking you with my heart,” the pope said to the president, Salva Kiir, and the opposition leader, Riek Machar, clutching his hands in front of his chest. “Stay in peace.”

The dramatic gesture happened during a spiritual retreat by the two men at the Vatican and came only hours after the military in neighboring Sudan ousted its longtime leader, President Omar al-Bashir, after 30 years of authoritarian rule.

Millions have sought refuge in neighboring countries

According to The New York Times, Pope Francis sat at his desk in a small room inside the Vatican facing the South Sudanese leaders, who were seated on a couch. The pope read remarks in which he said that while God’s gaze was on them, “there is another gaze directed to you: is the gaze of your people, and it expresses their ardent desire for justice, reconciliation and peace.”

The pope encouraged the two leaders to find common ground.

“I urge you, then, to seek what unites you, beginning with the fact that you belong to one and the same people, and to overcome all that divides you,” he said. “People are wearied, exhausted by past conflicts: Remember that with war, all is lost!”

At the conclusion of his speech, the pope offered some impromptu remarks, appealing to them again to keep the peace.

According to Human Rights Watch, since the start of the conflict, almost 2 million people have been internally displaced, and another 2 million have sought refuge in neighboring countries, with 1 million in Uganda alone. More than 230,000 people are sheltering in six United Nations bases in towns across the country. 

Sierra Leone: Kenema women launch governance network

By Ahmed Sahid Nasralla (De Monk)

Women unite: “Let us not relent and let no man intimidate us and tell us that we are not educated”

Women in Kenema have organised themselves into the Kenema Women in Governance Network seeking to empower themselves socially, economically, educationally and, most importantly, politically.

Drawing from the experiences and successes of their sisters in the Kailahun Women in Governance Network, the women said the time is now for them to take the podium in leadership and decision making in Sierra Leone.

“I believe this is the turning point wherein we have decided to confront the challenges preventing us from sitting side by side with the men in matters of politics and governance,” said Mary Wuyata Karimu, who chaired the launching program at Hotel Albertson, Kenema Town, last week.

Mary is the Chairperson of the Right to Access Information Commission (RAIC) Eastern Region.

“This is the time that the women of Sierra Leone should take the podium in leadership and decision making. Let us not relent and let no man intimidate us and tell us that we are not educated,” she added.

By the launching, Kenema Women in Governance Network is now an affiliate to Kailahun Women In Governance Network, which was formed in 2009. The formation of both women networks was supported by SEND Sierra Leone through funding from Irish Aid under the Women Participation in Governance Project. The Kenema project is specifically called Kenema Women Participation in Governance.

The network draws its membership from all 16 chiefdoms in Kenema District, with the district divided into four zones. Each zone has its executive which reports to the District Executive comprising of seven members. The district executive are elected from the four zones.

“Let me first and foremost, on behalf of our membership, commend the donors and SEND Sierra Leone for the trainings and support throughout the stages of the formation of this network. Our goal is to ensure more women take up political offices; come 2023, we want the numbers to increase remarkably. We know it will not be easy, but we are giving it a good fight,” said Fatmata Dassama, President of the Kenema women network; adding that they have started identifying women for key positions for the next national elections.

The women noted some of the key challenges holding them back, such as reprehensible culture and traditions and what they called pulling-down-syndrome. They also noted that the men in the Eastern region have not been treating women fairly in terms of political empowerment.   

To get the men onboard, Dassama revealed that the network has trained about 80 males in the district to help them convince more men to support the political course of women.

“If we want to quickly achieve our goal we need the support of the men; so let’s do all we can to convince them to get onboard. Let us start with our husbands or partners. Let us stay united and let’s talk positive things about our colleague women and rally behind those we have identified to be leaders in order to build Sierra Leone,” appealed Dassama.

Women constitute more than 51% of the population of Sierra Leone, and the Country Director of SEND Sierra Leone, Joseph Ayamga, said this statistics alone should be a source of strength for all women to pursue their dreams.

“If we are all here to talk about the business of women, it means that they are very much important. Women are the only people that add value to life. We are not launching the network to throw a challenge against the men. Rather, we are encouraging men and women to work together. We should give women their rights and remind them about their responsibilities as well.  All of us have our rights and responsibilities. Women have different skills same as men and that’s why we should work together,” said Ayamga.

He said any community or home where men and women are working together is better than where they are not and that is what they are trying to promote.

“The progress of women should not diminish the progress of men. We have women that are qualified to be chiefs, heads of political parties and councilors but why are we segregating them because of culture and tradition? We are trying to let you know that any society where women are lagging behind, it will never grow,” said Ayamga, adding that the essence of the women network is to fight for their colleagues to prosper in life by advocating for better social services and protection.  

The Resident Minster East, Andrew Fatorma, who also attended the ceremony, said in as much as women want leadership and improvement, they have to change their attitude.

“If you are advocating for men to work closely with you, you also have to support your colleagues when they seek leadership positions. Women in positions now should encourage those that don’t have the opportunity so you will be able to work as a team,” said the Resident Minister.

He continued: “You (women) have to work hard; it is not about coming together but you have to translate this into practical things. You have an assignment to do. It is not about promoting your interest alone. You have to think about helping and assisting those coming after you. I am happy because I have seen faces here that really want to promote the cause of women. We are ready to embrace you but it is your responsibility to push for it to happen.”

Meanwhile, giving the keynote address and formally lauching the network, the Deputy Director of the Ministry of Social Welfare, Gender and Children’s Affairs, Eastern Region, Jeneba Koroma,said every society is made up of weak and strong people and it’s very important for women to be part of governance.

“For governance to be very effective, men and women should always sit at the same table to take decisions because only then, the needs of everyone, including women, will be best met,” she said, adding that when women are in governance they cater for the family, community and the nation at large.

Following the formation of the women governance network in Kailahun, the district elected 12 women as councilors in the 2012 national elections, the highest in the entire country.

Credit: Development and Economic Journalists Association-Sierra Leone (DEJA-SL).