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BMJ No 7111 Volume 315 This week in brief Saturday 27 September 1997
HIV lowers life expectancy in Uganda HIV lowers life expectancy in UgandaAlthough the extent of the AIDS epidemic in sub-Saharan Africa is well documented, little data are available on its general effect on mortality. On p 767 Nunn et al report findings from a rural population cohort in south west Uganda which has been surveyed annually since 1989-90. About one in 10 of all adults were HIV-1 positive, and death rates among infected adults were 10 times higher than in people who were not infected. Almost half (41%) of all deaths in adults were due to HIV-1 infection, and in those aged 13-44 almost 70%. These data provide strong evidence that HIV-1 causes substantial excess mortality in Uganda and, by inference, in other populations in the developing world. Lumbar puncture should be used only with caution in suspected meningococcal diseaseA prolonged outbreak of meningococcal disease occurred in west Gloucestershire in the 1980s. On p 774, a clinical, microbiological, and epidemiological team reviews 14 years' experience of this disease, drawing attention to the dangers of lumbar puncture and the risk of potentially misleading results. The authors emphasise the need for a high index of clinical suspicion of meningococcal disease and the value of prompt antibiotic treatment and better diagnostic testing. Antenatal detection of haemoglobin disorders falls short of needTwo articles in this week's BMJ show that despite the effort devoted to antenatal screening for haemoglobin disorders in Britain, the service falls far short of meeting patients' needs. On p 779 Modell et al use national registers of patients and prenatal diagnoses to measure use of prenatal diagnosis (the proportion of pregnancies at risk in which prenatal diagnosis was performed). They found that use of prenatal diagnosis was less than 20% for sickle cell disorders and less than 50% for thalassaemias, with wide regional variations. However, when couples are counselled at a specialist centre in the first trimester of pregnancy, over 50% of those at risk of sickle cell disorders and 80% of those at risk of thalassaemias request prenatal diagnosis. In their study of screening for sickle cell disorders at a north London hospital Neuenschwander and Modell found that current practice leads to late identification, with consequent low use of prenatal diagnosis in both the presenting and subsequent pregnancies (p 784). For couples at risk to be given a fully informed choice, a clear policy is needed in each trust to promote carrier screening as early as possible, fast track referral for expert counselling, and counselling in the couple's own language. Two tests for HIV should be considered if there's a clinical suspicionIn March last year the manufacturer of an HIV antibody assay advised laboratories to stop using it after some false negative results had occurred. On p 772 Evans et al describe the results of the subsequent retesting programme done on samples tested with the assay between its introduction in July 1995 and March 1996. For over 24 000 patients testing negative with the assay almost 21 000 had stored specimens retested within three weeks of the recall: four gave positive results. Patients whose serum had not been stored were recalled for testing. The authors recommend that all laboratories screening specimens for HIV antibody should retain samples (most of the NHS and public health laboratories did, most of the private laboratories did not) and that where there is a clinical suspicion of HIV infection two assays should be performed. Dietary supplements in Gambian mothers lead to fewer low birthweight babiesOver 25 million babies a year are born with low birth weight (<2500 g)
and at increased risk of neonatal death. Most of these births occur in
developing countries, and the greatest cause - maternal
undernutrition - is theoretically amenable to intervention. Maternal
feeding programmes, however, remain controversial because of a lack of
well designed trials. Ceesay et al (p 786) describe a five year
randomised controlled trial of dietary supplementation during pregnancy
in over 2000 women from 28 Gambian vi
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