Browsing by Author "Katongole-Mbidde, Edward"

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    Dose-Modified Oral Chemotherapy in the Treatment of AIDS-Related Non-Hodgkin’s Lymphoma in East Africa
    (2009-05-26) Mwanda, Walter O; Orem, Jackson; Fu, Pingfu; Banura, Cecilia; Kakembo, Joweria; Onyango, Caren Auma; Ness, Anne; Reynolds, Sherrie; Johnson, John L.; Subbiah, Vivek; Bako, Jacob; Wabinga, Henry; Abdallah, Fatuma K.; Meyerson, Howard J.; Whalen, Christopher C.; Lederman, Michael M.; Black, Jodi; Ayers, Leona W.; Ayers, Leona W.; Katongole-Mbidde, Edward; C., Scot; Remick, Scot C.
    Purpose Africa is burdened by the AIDS epidemic and attendant increase in HIV/AIDS-related malignancies. Pragmatic approaches to therapeutic intervention could be of great value. Dose-modified oral chemotherapy for AIDS-related non-Hodgkin's lymphoma is one such approach. Patients and Methods The oral regimen consisted of lomustine 50 mg/m2 on day 1 (cycle 1 only), etoposide 100 mg/m2 on days 1 to 3, and cyclophosphamide/procarbazine 50 mg/m2 each on days 22 to 26 at 6-week intervals (one cycle) for two total cycles in HIV-infected patients with biopsy-proven non-Hodgkin's lymphoma. Results Forty-nine patients (21 in Uganda and 28 in Kenya) were treated. The majority of patients were female (59%) and had a poor performance status (63%); 69% of patients had advanced-stage disease; and 18 patients (37%) had access to antiretroviral therapy. In total, 79.5 cycles of therapy were administered. The regimen was well tolerated, had modest effects (decline) on CD4+ lymphocyte counts (P = .077), and had negligible effects on HIV-1 viral replication. Four febrile neutropenia episodes and three treatment-related deaths (6% mortality rate) occurred. The overall objective response rate was 78% (95% CI, 62% to 88%); median follow-up time was 8.2 months (range, 0.1 to 71 months); median event-free and overall survival times were 7.9 months (95% CI, 3.3 to 13.0 months) and 12.3 months (95% CI, 4.9 to 32.4 months), respectively; and 33% of patients survived 5 years. Conclusion Dose-modified oral chemotherapy is efficacious, has comparable outcome to that in the United States in the pre–highly active antiretroviral therapy setting, has an acceptable safety profile, and is pragmatic in sub-Saharan Africa. The international collaboration has been highly successful, and subsequent projects should focus on strategies to optimize combination antiretroviral therapy and chemotherapy and follow-up tissue correlative studies.
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    Hematological Reference Ranges among Healthy Ugandans
    (Clinical Diagnostic Laboratory Immunology, 1995) Tugume, Sitefano B.; Piwowar, Estelle M.; Lutalo, Tom; Mugyenyi, Peter N.; Grant, Robert M.; Mangeni, Fred W.; Pattishall, Katherine; Katongole-Mbidde, Edward
    An estimated 8 million individuals living in sub-Saharan Africa (including Uganda) are infected with the human immunodeficiency virus (HIV) (2). Infection with HIV results in progressive generalized immune suppression due predominantly to cytopathic effects of HIV type 1 (HIV-1) on CD41 T-helper–T-inducer lymphocytes (6). HIV also suppresses normal hematopoiesis and is associated with a broad spectrum of hematologic abnormalities. Measurements of the peripheral blood absolute CD4 cell count (ACD4), CD4 percentage (%CD4), and CD4/CD8 ratio have been found to be useful surrogates for determining the risk of progression of HIV infection and are extensively used in observational studies and AIDS clinical trials (7). Many AIDS-related research studies are being conducted in Uganda and other African nations with a high prevalence of HIV infection. Because of the lack of normal reference ranges for hematological parameters in healthy subjects, many investigators interpret their data using normal values derived from populations in Europe and the United States. There is a need to establish appropriate normal reference values for hematologic parameters in African populations. In this report, we describe hematologic reference ranges obtained by studying 183 symptom-free HIV-seronegative Ugandans. (Results of this investigation were presented at the Eighth International Conference on AIDS in Africa, Marrakesh, Morocco, December 1993.)
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    Schistosomiasis among Recreational Users of Upper Nile River, Uganda, 2007
    (Emerging infectious diseases, 2010) Morgan, Oliver W.; Brunette, Gary; Kapella, Bryan K.; McAuliffe, Isabel; Katongole-Mbidde, Edward; Li, Wenkai; Marano, Nina; Okware, Sam; Olsen, Sonja J.; Secor, W. Evan; Tappero, Jordan W.; Wilkins, Patricia P.; Montgomery, Susan P.
    Schistosomiasis, a parasitic infection caused by schistosome fl ukes, affects 207 million persons worldwide, mostly in sub-Saharan Africa (1). Schistosomiasis has been reported among travelers (2–12); 3 outbreaks have been reported among white-water rafters on the Omo River in Ethiopia (2,7,10). During September–November 2007, the Centers for Disease Control and Prevention (CDC) received reports of schistosome infection among travelers returning from white-water rafting on the Nile River, Jinja District, Uganda. Approximately 12,000 persons raft each year in Uganda, and local rafting companies believe that exposure to fast-moving white water during rafting and kayaking presents a low risk for schistosomiasis
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    Therapeutic Challenges of AIDS-Related Non-Hodgkin’s Lymphoma in the United States and East Africa
    (2002-05) Otieno, Mwanda W.; Banura, Cecily; Katongole-Mbidde, Edward; Johnson, John L.; Dowlati, Afshin; Renne, Rolf; Arts, Eric; Whalen, Christopher; Lederman, Michael M.; Remick, Scot C.
    Abstract Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.