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Background: A community-randomised trial was undertaken to assess the impact, cost, and cost-effectiveness of averting HIV-1 infection through improved management of sexually transmitted diseases (STDs) by primary-health-care workers in Mwanza Region, Tanzania., Methods: The impact of improved treatment services for STDs on HIV-1 incidence was assessed by comparison of six intervention communities with six matched communities. We followed up a random cohort of 12,537 adults aged 15-54 years for 2 years to record incidence of HIV-1 infection. The total and incremental costs of the intervention were estimated (ingredients approach) and used to calculate the total cost per case treated, the incremental cost per HIV-1 infection averted, and the incremental cost per disability-adjusted life-year (DALY) saved., Findings: During 2 years of follow-up, 11,632 cases of STDs were treated in the intervention health units. The baseline prevalence of HIV-1 infection was 4%. The incidence of HIV-1 infection during the 2 years was 1.16% in the intervention communities and 1.86% in the comparison communities. An estimated 252 HIV-1 infections were averted each year. The total annual cost of the intervention was US$59,060 (1993 prices), equivalent to $0.39 per head of population served. The cost for STD case treated was $10.15, of which the drug cost was $2.11. The incremental annual cost of the intervention was $54,839, equivalent to $217.62 per HIV-1 infection averted and $10.33 per DALY saved (based on Tanzanian life expectancy) or $9.45 per DALY saved (based on the assumptions of the World Development Report). In a sensitivity analysis of factors influencing cost-effectiveness, cost per DALY saved ranged from $2.51 to $47.86., Interpretation: Improved management of STDs in rural health units reduced the incidence of HIV-1 infection in the general population by about 40%. The estimated cost-effectiveness of this intervention ($10 per DALY) compares favourably with that of, for example, childhood immunisation programmes ($12-17 per DALY). Cost-effectiveness should be further improved when the intervention is applied on a larger scale. Resources should be made available for this highly cost-effective HIV control strategy.

Tumor necrosis factor (TNF) exhibits cytotoxic or cytostatic activity on a wide range of animal and human transformed cell lines. Using pure, recombinant human and mouse TNF, we examined the degree of species specificity of the in vitro TNF activity on a variety of human and murine transformed cell lines. This species specificity was studied for the TNF activity alone or in synergism with IFN-gamma. Recombinant human and mouse TNF behave remarkably similarly regarding the in vitro cytolytic/cytostatic activity. However, a certain degree of species-specific preference could be revealed as human cell lines needed a higher concentration of recombinant mouse TNF than of recombinant human TNF to attain a similar effect, while on mouse cells the reverse was true. Also, synergism with IFN-gamma seemed more effective when the target cell was treated with homologous TNF.

117 infants with gonococcal ophthalmia neonatorum, including 27 with infections due to penicillinase-producing Neisseria gonorrhoeae, were treated as outpatients with five different regimens of single-dose intramuscular kanamycin (75 mg or 150 mg) with saline eye washes, gentamicin eye ointment, or chloramphenicol eye drops. There were no treatment failures among 68 patients treated with 75 mg or 150 mg kanamycin and gentamicin eye ointment (for 3 days). However, the minimum and maximum cumulative probabilities of cure of single-dose kanamycin with saline eye washes (for 3 days) were only 60% and 89%. 1 patient of 15 treated with 150 mg kanamycin plus chloramphenicol eye drops did not respond to treatment. Postgonococcal conjunctivitis developed in 14 (12%) infants, of whom 13 had positive cultures for Chlamydia trachomatis. Nasopharyngeal infection with N gonorrhoeae was eradicated in 9 of 11 infants colonised.

The immunomodulatory effect of thymopentin as therapy in genital warts of long duration and the proliferative responses of the patient's peripheral blood mononuclear cells were investigated in this pilot study. The observations in 6 patients suggest that subcutaneous injections of thymopentin (50 mg) beneficially influence the systems of therapy-resistant genital warts. The small number of patients and controls used in the assessment of the proliferation responses allows only a descriptive analysis of the results, but definitive trends can be observed in the Con A- and PHA-induced proliferation tests. These clinical observations, the theoretical considerations, and the low rate of side effects of thymopentin reported also by other investigators all emphasize the importance of further well-controlled double-blind studies on the treatment of genital warts with thymopentin.