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30 results on '"Kleppa, Elisabeth"'

1. Diagnosis of female genital schistosomiasis and other genital infections in young South African women: challenges in the syndromic approach

Author

Søfteland, Solrun, primary, Sebitloane, Motshedisi, additional, Galappaththi-Arachchige, Hashini Nilushika, additional, Kleppa, Elisabeth, additional, Holmen, Sigve, additional, Pillay, Pavitra, additional, Ndhlovu, Patrica Doris, additional, Taylor, Myra, additional, Vennervald, Birgitte Jyding, additional, Naidoo, Saloshni, additional, Staff, Anne Cathrine, additional, Makua, Manala, additional, Gundersen, Svein Gunnar, additional, and Kjetland, Eyrun Floerecke, additional

Published
2024
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2. Clinical trial: An open‐label, randomised trial of different re‐start strategies after treatment withdrawal in HBeAg negative chronic hepatitis B.

Author

Johannessen, Asgeir, Reikvam, Dag Henrik, Aleman, Soo, Berhe, Nega, Weis, Nina, Desalegn, Hailemichael, Stenstad, Tore, Heggelund, Lars, Samuelsen, Ellen, Karlsen, Lars Normann, Lindahl, Karin, Pettersen, Frank Olav, Iversen, Jonas, Kleppa, Elisabeth, Bollerup, Signe, Winckelmann, Anni Assing, Brugger‐Synnes, Pascal, Simonsen, Hans Erling, Svendsen, Jan, and Kran, Anne‐Marte Bakken

Subjects
CHRONIC hepatitis B, TERMINATION of treatment, CLINICAL trials
Abstract

Summary: Background: Stopping nucleos(t)ide analogue (NA) therapy in patients with chronic hepatitis B (CHB) may trigger a beneficial immune response leading to HBsAg loss, but clinical trials on re‐start strategies are lacking. Aim: To assess whether it is beneficial to undergo a prolonged flare after NA cessation. Methods: One‐hundred‐and‐twenty‐seven patients with HBeAg negative, non‐cirrhotic CHB with at least 24 months of viral suppression on NA therapy were included. All study participants stopped antiviral therapy and were randomised to either low‐threshold (ALT > 80 U/L and HBV DNA > 2000 IU/mL) or high‐threshold (ALT > 100 U/L for >4 months, or ALT > 400 U/L for >2 months) for the re‐start of therapy. The primary endpoint was HBsAg loss within 36 months of stopping antiviral treatment. The primary analysis was based on intention‐to‐treat allocation with last observation carried forward. Results: There was a numerical but not statistically significant difference in HBsAg loss between the low‐threshold (3 of 64; 4.7%) and the high‐threshold (8 of 63; 12.7%) group (risk difference: 8.0%, 95% CI: −2.3 to 19.6, p = 0.123). None of the patients with end‐of‐treatment HBsAg > 1000 IU/mL achieved HBsAg loss; among those with end‐of‐treatment HBsAg < 1000 IU/mL, 8 of 15 (53.3%) achieved HBsAg loss in the high‐threshold group compared to 3 of 26 (11.5%) in the low‐threshold group. Conclusions: We could not confirm our hypothesis that a higher threshold for restart of therapy after NA withdrawal improves the likelihood of HBsAg loss within 36 months in patients with HBeAg negative CHB. Further studies including only patients with HBsAg level <1000 IU/mL and/or larger sample size and longer follow‐up duration are recommended. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Predictors for participation in mass-treatment and female genital schistosomiasis re-investigation, and the effect of praziquantel treatment in South African adolescents

Author

Nemungadi, Takalani Girly, primary, Kleppa, Elisabeth, additional, Galappaththi-Arachchige, Hashini Nilushika, additional, Pillay, Pavitra, additional, Gundersen, Svein Gunnar, additional, Vennervald, Birgitte Jyding, additional, Ndhlovu, Patricia Doris, additional, Taylor, Myra, additional, Naidoo, Saloshni, additional, and Kjetland, Eyrun Floerecke, additional

Published
2024
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4. The Association Between Female Genital Schistosomiasis and Other Infections of the Lower Genital Tract in Adolescent Girls and Young Women: A Cross-Sectional Study in South Africa

Author

Shukla, Jilna Dilip, primary, Kleppa, Elisabeth, additional, Holmen, Sigve, additional, Ndhlovu, Patricia D., additional, Mtshali, Andile, additional, Sebitloane, Motshedisi, additional, Vennervald, Birgitte Jyding, additional, Gundersen, Svein Gunnar, additional, Taylor, Myra, additional, and Kjetland, Eyrun Floerecke, additional

Published
2023
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6. Female Genital Schistosomiasis Lesions Explored Using Circulating Anodic Antigen as an Indicator for Live Schistosoma Worms

Author

Nemungadi, Takalani Girly, primary, Kleppa, Elisabeth, additional, van Dam, Govert J., additional, Corstjens, Paul L. A. M., additional, Galappaththi-Arachchige, Hashini Nilushika, additional, Pillay, Pavitra, additional, Gundersen, Svein Gunnar, additional, Vennervald, Birgitte J., additional, Ndhlovu, Patricia, additional, Taylor, Myra, additional, Naidoo, Saloshni, additional, and Kjetland, Eyrun F., additional

Published
2022
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9. Mapping Schistosoma haematobium for Novel Interventions against Female Genital Schistosomiasis and Associated HIV Risk in KwaZulu-Natal, South Africa

Author

Livingston, Mahala, primary, Pillay, Pavitra, additional, Zulu, Siphosenkosi Gift, additional, Sandvik, Leiv, additional, Kvalsvig, Jane Dene, additional, Gagai, Silindile, additional, Galappaththi-Arachchige, Hashini Nilushika, additional, Kleppa, Elisabeth, additional, Ndhlovu, Patricia, additional, Vennervald, Birgitte, additional, Gundersen, Svein Gunnar, additional, Taylor, Myra, additional, and Kjetland, Eyrun F., additional

Published
2021
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11. Female genital schistosomiasis and reproductive tract infections. A cross-sectional study in rural adolescents in South Africa

Author

Shukla, Jilna Dilip, primary, Kleppa, Elisabeth, additional, Holmen, Sigve, additional, Ndhlovu, Patricia D., additional, Mtshali, Andile, additional, Sebitloane, Motshedisi, additional, Vennervald, Birgitte Jyding, additional, Gundersen, Svein Gunnar, additional, Taylor, Myra, additional, and Kjetland, Eyrun Floerecke, additional

Published
2019
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12. Experimental Infection of Human Volunteers with the Heat-Stable Enterotoxin-Producing Enterotoxigenic Escherichia coli Strain TW11681

Author

Todnem Sakkestad, Sunniva, primary, Steinsland, Hans, additional, Skrede, Steinar, additional, Kleppa, Elisabeth, additional, Lillebø, Kristine, additional, Sævik, Marianne, additional, Søyland, Hanne, additional, Rykkje Heien, Astrid, additional, Gjerde Tellevik, Marit, additional, Barry, Eileen M., additional, Sommerfelt, Halvor, additional, and Hanevik, Kurt, additional

Published
2019
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13. Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa

Author

Galappaththi-Arachchige, Hashini Nilushika, primary, Holmen, Sigve, additional, Koukounari, Artemis, additional, Kleppa, Elisabeth, additional, Pillay, Pavitra, additional, Sebitloane, Motshedisi, additional, Ndhlovu, Patricia, additional, van Lieshout, Lisette, additional, Vennervald, Birgitte Jyding, additional, Gundersen, Svein Gunnar, additional, Taylor, Myra, additional, and Kjetland, Eyrun Floerecke, additional

Published
2018
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17. Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa

Author

Galappaththi-Arachchige, Hashini, primary, Amlie Hegertun, Ingrid, additional, Holmen, Sigve, additional, Qvigstad, Erik, additional, Kleppa, Elisabeth, additional, Sebitloane, Motshedisi, additional, Ndhlovu, Patricia, additional, Vennervald, Birgitte, additional, Gundersen, Svein, additional, Taylor, Myra, additional, and Kjetland, Eyrun, additional

Published
2016
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18. HIV susceptibility related to HIV target cells and cervical ectopy. A study of young South African women living in a rural area endemic of urogenital schistosomiasis

Author

Kleppa, Elisabeth

Abstract

More than 110 million Africans are estimated to be infected with Schistosoma (S.) haematobium, but it is still one of the so-called “neglected tropical diseases”. Poor countries bear the majority of the disease burden, contributing to the maintenance of the cycle of poverty. In Africa, women are at a higher risk of human immunodeficiency virus (HIV) infection than men, and this cannot be explained by behavioural factors alone. Biological risk factors seem to contribute to the differences in HIV prevalence between geographical regions and genders. This thesis will focus on female genital schistosomiasis and cervical ectopy, both factors hypothesised to facilitate the transmission of HIV through the genital mucosa. Genital schistosomiasis in women is characterized by lesions referred to as “sandy patches” that appear grainy or homogenous and are thought to be caused by the deposition of ova in the genital tissues. Sandy patches are often associated with abnormal mucosal blood vessels and contact bleeding due to the fragile mucosa. Cervical ectopy and female genital schistosomiasis (FGS) may be diagnosed by photocolposcopic examination, and both conditions are likely to be present before sexual debut. In addition to increased susceptibility to HIV infection, S. haematobium infection has been suggested to accelerate the progression of HIV infection, possibly through increased immune activation. In this study, South African women attending high schools in KwaZulu-Natal were included. Blood, urine and cervical lavage samples were collected and a photocolposcopic examination performed. We found that FGS was associated with a higher frequency of HIV target cells and HIV co-receptor expression in the genital compartment (the proportion of CD14+CCR5+ cells was higher in FGSpositive (FGS+) than FGS-negative (FGS-), p = 0.036) and in blood (both the proportions of CD14+ cells (p = 0.042), and CD4+CCR5+ cells (p = 0.018) were higher in FGS+). Furthermore, praziquantel treatment decreased the proportion of HIV target cells in FGS-positive women. Both the CD14+ cell population and CCR5 expression by CD4+ cells decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043 and 0.025, respectively). We found no significant difference in CD4 cell counts in women with or without S. haematobium infection. Furthermore, we found that cervical ectopy was associated with the prevalence of chlamydia infection (adjusted OR 1.78, p = 0.033) and with HIV infection in the youngest study subjects (OR 2.19, p = 0.014). Future studies are needed to show whether treatment of schistosomiasis and/or intervention against cervical ectopy may become tools in the battle against the HIV epidemic.

Published
2015

19. Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract

Author

Kleppa, Elisabeth, Ramsuran, Veron, Zulu, Siphosenkosi, Karlsen, Gunn Hege, Bere, Alfred, Passmore, Jo-Ann S, Ndhlovu, Patricia, Lillebø, Kristine, Holmen, Sigve D, Onsrud, Mathias, Division of Virology, and Faculty of Health Sciences

Subjects
T cells, HIV, Schistosomiasis, Schistosoma, Monocytes, HIV infections
Abstract

BACKGROUND: Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. METHODS: Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). RESULTS: FGS was associated with a higher frequency of CD14 + cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4 + cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14 + cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). CONCLUSIONS: The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this.

Published
2014
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24. The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

Author

Norseth, Hanne M., primary, Ndhlovu, Patricia D., additional, Kleppa, Elisabeth, additional, Randrianasolo, Bodo S., additional, Jourdan, Peter M., additional, Roald, Borghild, additional, Holmen, Sigve D., additional, Gundersen, Svein G., additional, Bagratee, Jayanthilall, additional, Onsrud, Mathias, additional, and Kjetland, Eyrun F., additional

Published
2014
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26. Effect of Female Genital Schistosomiasis and Anti-Schistosomal Treatment on Monocytes, CD4+ T-Cells and CCR5 Expression in the Female Genital Tract

Author

Kleppa, Elisabeth, primary, Ramsuran, Veron, additional, Zulu, Siphosenkosi, additional, Karlsen, Gunn Hege, additional, Bere, Alfred, additional, Passmore, Jo-Ann S., additional, Ndhlovu, Patricia, additional, Lillebø, Kristine, additional, Holmen, Sigve D., additional, Onsrud, Mathias, additional, Gundersen, Svein Gunnar, additional, Taylor, Myra, additional, Kjetland, Eyrun F., additional, and Ndung’u, Thumbi, additional

Published
2014
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27. Real-Time Polymerase Chain Reaction for Detection of Schistosoma DNA in Small-Volume Urine Samples Reflects Focal Distribution of Urogenital Schistosomiasis in Primary School Girls in KwaZulu Natal, South Africa

Author

Pillay, Pavitra, primary, Kjetland, Eyrun F., additional, Brienen, Eric A. T., additional, Taylor, Myra, additional, van Lieshout, Lisette, additional, Gundersen, Svein G., additional, Hoekstra, Pytsje, additional, Zulu, Siphosenkosi G., additional, Verweij, Jaco J., additional, and Kleppa, Elisabeth, additional

Published
2014
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29. Effect of Female Genital Schistosomiasis and Anti-Schistosomal Treatment on Monocytes, CD4+ T-Cells and CCR5 Expression in the Female Genital Tract.

Author

Kleppa, Elisabeth, Ramsuran, Veron, Zulu, Siphosenkosi, Karlsen, Gunn Hege, Bere, Alfred, Passmore, Jo-Ann S., Ndhlovu, Patricia, Lillebø, Kristine, Holmen, Sigve D., Onsrud, Mathias, Gundersen, Svein Gunnar, Taylor, Myra, Kjetland, Eyrun F., and Ndung’u, Thumbi

Subjects
*SCHISTOSOMIASIS, *FEMALE reproductive organs, *SCHISTOSOMA, *MONOCYTES, *CD4 antigen, *T cells, *GENE expression, *THERAPEUTICS
Abstract

Background: Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design: The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. Methods: Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). Results: FGS was associated with a higher frequency of CD14+ cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4+ cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14+ cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). Conclusions: The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this. [ABSTRACT FROM AUTHOR]

Published
2014
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30. S. haematobium as a Common Cause of Genital Morbidity in Girls: A Cross-sectional Study of Children in South Africa.

Author

Amlie Hegertun, Ingrid Elise, Sulheim Gundersen, Kristin Marie, Kleppa, Elisabeth, Zulu, Siphosenkosi Gift, Gundersen, Svein Gunnar, Taylor, Myra, Kvalsvig, Jane D., and Floerecke Kjetland, Eyrun

Subjects
SCHISTOSOMA haematobium, FEMALE reproductive organ diseases, ETIOLOGY of diseases, SYMPTOMS, CROSS-sectional method
Abstract

Background: Schistosoma (S.) haematobium infection is a common cause of genital morbidity in adult women. Ova in the genital mucosal lining may cause lesions, bleeding, pain, discharge, and the damaged surfaces may pose a risk for HIV. In a heterogeneous schistosomiasis endemic area in South Africa, we sought to investigate if young girls had genital symptoms and if this was associated with urinary S. haematobium. Methodology: In a cross-sectional study of 18 randomly chosen primary schools, we included 1057 schoolgirls between the age of 10 and 12 years. We interviewed assenting girls, whose parents had consented to their participation and examined three urines from each of them for schistosome ova. Principal findings: One third of the girls reported to have a history of genital symptoms. Prior schistosomal infection was reported by 22% (226/1020), this was associated with current genital symptoms (p,0.001). In regression analysis the genital symptoms were significantly associated both with urinary schistosomiasis (p,0.001) and water contact (p,0.001). Conclusions: Even before sexually active age, a relatively large proportion of the participating girls had similar genital symptoms to those reported for adult genital schistosomiasis previously. Anti-schistosomal treatment should be considered at a young age in order to prevent chronic genital damage and secondary infections such as HIV, sexually transmitted diseases and other super-infections. [ABSTRACT FROM AUTHOR]

Published
2013
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