Health outcomes of HIV-associated neurocognitive disorders in Africa

HIV-associated neurocognitive disorders (HAND) may affect up to 4.4 million individuals in sub-Saharan Africa. Individuals with HAND in resource-rich settings have been shown to have higher mortality, lower adherence, and lower quality of life. The impact of HAND on health and economic outcomes has not been studied in Africa, despite the fact that the vast majority of people living with HIV/AIDS reside in Africa. We will enroll a prospective observational cohort of 200 HIV-infected ART-naïve adults with and without HIV-associated cognitive impairment and assess their health and economic outcomes over one year.

Early Cryptococcal infection in high-risk HIV infected individuals in resource limited settings

In sub-Saharan Africa and southeast Asia, invasive cryptococcal disease is the second most common life-threatening HIV-associated opportunistic infection after tuberculosis and is responsible for up to 20% of deaths.

Treatment of Early Cryptococcal Infection

Preliminary evidence suggests that fluconazole monotherapy is not an effective treatment in a heterogeneous population of individuals with early cryptococcal infection. This phase IIb clinical trial is designed to provide a screening evaluation for the hypothesis that combination therapy with fluconazole and flucytosine improves survival as compared to fluconazole alone for the treatment of early cryptococcal infection in HIV-infected individuals with advanced immunosuppression.

Environment Risk Factors for Cryptococcal Infection

In this pilot study, we will develop and pilot test methods to identify the environmental reservoir(s) and define the molecular characteristics of Cryptococcus spp. in the homesteads of individuals co-infected with HIV and Cryptococcus in Kisumu and Homa Bay counties. A better understanding of how and when individuals acquire cryptococcal infection will help guide subsequent prevention efforts.

The association between epilepsy and neurocysticercosis in Western Kenya

Neurocysticercosis is the leading cause of acquired epilepsy worldwide. However, little is known about the prevalence of neurocysticercosis and its relative contribution to epilepsy in Africa. We will determine the prevalence of epilepsy and its association with neurocysticercosis in a community based study of livestock and non-livestock keepers in Western Kenya.