The Need for Adult Pneumococcal Vaccination in Nigeria.

Despite universal immunization coverage on a global scale among children, the vast majority of immunocompromised adults, and particularly the elderly, remain unvaccinated. Considering that a significant proportion of mortality from pneumococcal disease occurs among the elderly, preventive measures through pneumococcal vaccination in adults, especially the elderly with co-morbidities, needs to be urgently explored and implemented in Africa, and particularly in Nigeria, to stem the tide of deaths resulting from pneumococcal disease among this population. This article looks at the pneumococcal epidemiology and burden of disease in Nigeria, as well as the vaccines available and the rationale for adult pneumococcal vaccination.

Genomic medicine: health care issues and the unresolved ethical and social dilemmas.

Our perception of the mechanism by which single genes can cause disease is evolving. This has led to the understanding of the pathophysiological basis of common diseases. Genomic Medicine continues to contribute to the understanding of the molecular basis of disease.

Lassa virus infection in Nigeria: clinical perspective overview.

Lassa fever is a severe, often fatal, hemorrhagic fever caused by Lassa virus, an Arenavirus that can be transmitted to humans from asymptomatically infected multimammate rats. The speculation is that Lassa viral infection may affect between 2 to 3 million people each year in certain portions of the West African region, causing a mortality of about 10000 during the same period. Lassa fever is one of the endemic zoonosis in Nigeria with a high probability for nosocomial transmission due to several health care sector challenges.

Diabetes in sub-Saharan Africa: health care perspectives, challenges, and the economic burden of disease.

The growing incidence of diabetes mellitus in the world is a widespread concern. While there has been improvement in the epidemiology and management of the disease in the developed world, the same cannot be said in sub-Saharan Africa. The disease is getting less attention as is the funding that it merits compared to communicable diseases.

HIV and tuberculosis coinfection: inextricably linked liaison.

In sub-Saharan Africa, human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (TB) are among the leading causes of morbidity and mortality. Sub-Saharan Africa has seen the woeful failure of World Health Organization (WHO) targets of detecting 70% of the infectious cases of tuberculosis and curing > or =85%. Current treatment of Mycobacterium tuberculosis in most resource limited settings is comprised of a four-drug initial antituberculosis regimen for two months, followed by either a two-drug continuation phase of antituberculosis regimen for four months or six months depending on the medications.

Human immunodeficiency virus (HIV) and malaria interaction in sub-Saharan Africa: the collision of two Titans.

HIV and malaria are among the leading causes of morbidity and mortality in sub-Saharan Africa, home to 10% of the world's population. An association between HIV and malaria is expected in theory, however, there is conflicting evidence regarding the impact of HIV infection on parasite loads. HIV-associated immunosuppression contributes to more frequent and more severe malaria and reduced efficacy of antimalarials in pregnant women and adults.

Human immunodeficiency virus (HIV) entry inhibitors (CCR5 specific blockers) in development: are they the next novel therapies?

Since the introduction of the nucleoside reverse transcriptase inhibitor zidovudine in 1987, the number of the available antiretroviral medications has grown to about 20. Despite the efficacy of these medications, treatment-limiting adverse events are frequent. During the last several years, a new class of antiretroviral drugs often referred to as entry inhibitors, specifically the CCR5 blockers, have moved from the basic science laboratories and are now in the clinical phases of drug development.

The 2004 International AIDS Conference and how to globally counter HIV/AIDS.

This article reports noteworthy HIV/AIDS clinical trials presented at the XVth International AIDS Conference, Bangkok, July 2004, and also outlines goals of comprehensive prevention, care, treatment, and monitoring plans. The Bangkok conference theme was "Access for All." Outlined are goals of comprehensive prevention, care, and treatment programs: increased education and prevention efforts, greater involvement of national health authorities, reduction of new HIV infections, increased use of voluntary counseling and testing, increased acceptance and use of condoms, acceptance of an individual's right to be protected against HIV infection during sexual activity, increased support of NGOs, reduction of sexual partners, increased sexual fidelity, availability of antiretroviral medication, prevention of mother-to-child transmission, reduction of AIDS deaths, improved surveillance of sexually transmitted infections, improved blood supply security, increased coordination with tuberculosis and malaria treatment, equity for urban and rural persons, increased orphan services, reduction of orphan rate, greater involvement of local leaders, increased media involvement, reducing HIV/AIDS discussion taboo, reduced injecting drug user needle sharing, and continuing education for health care professionals.

Emerging opportunistic fungal infections: where are we heading?

Medical mycology involves the study of pathogenic fungi and their identification in the laboratory. Mycology has developed into a field that demands the attention of all clinicians treating patients in hospitals. Interest in medical mycology has grown in recent years due to a dramatic rise in the rates of fungal infections.

Human immunodeficiency virus: scientific challenges impeding candidate vaccines.

Most initial work with HIV vaccines was directed at developing vaccines that elicited neutralizing antibodies. These neutralizing antibodies have been narrow in the focus of their action and specific almost entirely to the strain of the innoculating virus. Additionally, controversy has been reported about both the design of assay systems to measure the neutralization of such isolates and interpretation of the results.

The concept of structured treatment interruptions in the management of patients with human immunodeficiency virus (HIV) disease: where are we currently?

The failure to achieve viral eradication with currently available antiretroviral agents has spawned new approaches to limiting drug exposure. Highly active antiretroviral therapy (HAART) lowers morbidity and mortality of HIV disease but cannot eradicate the virus from the body. Structured treatment interruptions (STIs) have been proposed as a strategy to minimize the toxicities of HAART while providing a mechanism to enhance HIV-specific immunity.

20 years since human immunodeficiency virus discovery: considerations for the next decade.

The year 2003 marks the 20th anniversary of the discovery of the human immunodeficiency virus type 1 (HIV-1). Among infectious disease-causing agents, HIV-1 is now the number one killer worldwide. Approximately 70% of the cases in the world are in sub-Saharan Africa, where in some regions, the seroprevalence of HIV-1 among adults exceeds 25%.

The evolving role of antiretroviral drug resistance testing in HIV-infected individuals.

Scientific advances have made HIV resistance testing routinely available to clinicians and other HIV caregivers. However, interpretation of HIV resistance results is complicated by the lack of knowledge of the clinical consequences of specific genotypic and phenotypic results for most antiretroviral agents. Limitations of viral genotype and phenotype HIV resistance testing include factors such as lack of uniform quality assurance, turn around time, cost, and insensitivity to those mutant strains present in less than 20% to 30% of the viral population.

Promising microbicide approach for prevention of human immunodeficiency virus transmission needs more support.

The human immunodeficiency virus (HIV) is the number one killer worldwide among infectious disease-causing agents. Because of the speed at which the epidemic has spread, it is crucial for the global community to expand female-controlled preventive options such as the use of microbicides. Much of microbicide research explores how HIV crosses the mucous membranes of the female genital tract and how the virus can be blocked at that point.

Human immunodeficiency viruses and drug therapy: resistance and implications for antiretroviral therapy.

Through a concerted effort to combat the human immunodeficiency virus (HIV) epidemic, researchers have made significant strides in molecular biology, virology, and immunology, which have resulted in an increased understanding of the complexities of this infection. The biggest obstacle to the success of current HIV therapy, however, is the emergence of viral resistance. Viral resistance is caused by mutations in the HIV-1 genome coding for structural changes in the target enzymes that can affect the binding or activity of the inhibitors.

Continuing debate over HIV therapy initiation.

Initiation of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infection has changed the landscape of HIV/AIDS care. However, the potential for long-term complications from therapy has emerged, and the risk/benefit associated with usage now merits more extensive evaluation. As data from ongoing and future clinical trials continue to accumulate, individualization of therapy may be the appropriate option for HIV-infected individuals.

It's time to step up the management of community-acquired pneumonia.

Optimal therapy for serious Streptococcal pneumoniae infections with intermediate or high-grade resistance to penicillin is controversial. It should be noted that data regarding the efficacy of penicillins or cephalosporins for penicillin-resistant strains are limited. Despite the paucity of clinical trials, most clinicians still agree that penicillins remain the mainstay of therapy for community-acquired pneumonia caused by Streptococcal pneumoniae-susceptible strains.