Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda
Identifieur interne : 004885 ( Main/Exploration ); précédent : 004884; suivant : 004886Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda
Auteurs : Warren Phipps [États-Unis] ; Fred Ssewankambo [Ouganda] ; Huong Nguyen [États-Unis] ; Misty Saracino [États-Unis] ; Anna Wald [États-Unis] ; Lawrence Corey [États-Unis] ; Jackson Orem [Ouganda] ; Andrew Kambugu [Ouganda] ; Corey Casper [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2010.
Descripteurs français
- KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Analyse multivariée, Antirétroviraux (usage thérapeutique), Estimation de Kaplan-Meier, Facteurs sexuels, Femelle, Humains, Incidence, Infections à VIH (), Infections à VIH (traitement médicamenteux), Jeune adulte, Modèles de hasards proportionnels, Modèles logistiques, Mâle, Numération des lymphocytes CD4, Ouganda (épidémiologie), Sarcome de Kaposi (), Sarcome de Kaposi (traitement médicamenteux), Sarcome de Kaposi (épidémiologie), Épidémies, Évaluation de résultat (soins) ().
- MESH :
- traitement médicamenteux : Infections à VIH, Sarcome de Kaposi.
- usage thérapeutique : Antirétroviraux.
- épidémiologie : Ouganda, Sarcome de Kaposi.
- Adolescent, Adulte, Adulte d'âge moyen, Analyse multivariée, Estimation de Kaplan-Meier, Facteurs sexuels, Femelle, Humains, Incidence, Infections à VIH, Jeune adulte, Modèles de hasards proportionnels, Modèles logistiques, Mâle, Numération des lymphocytes CD4, Sarcome de Kaposi, Épidémies, Évaluation de résultat (soins).
- Wicri :
- geographic : Ouganda.
English descriptors
- KwdEn :
- Adolescent, Adult, Anti-Retroviral Agents (therapeutic use), CD4 Lymphocyte Count, Epidemics, Female, HIV Infections (complications), HIV Infections (drug therapy), Humans, Incidence, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Multivariate Analysis, Outcome Assessment (Health Care) (statistics & numerical data), Proportional Hazards Models, Sarcoma, Kaposi (complications), Sarcoma, Kaposi (drug therapy), Sarcoma, Kaposi (epidemiology), Sex Factors, Uganda (epidemiology), Young Adult.
- MESH :
- chemical , therapeutic use : Anti-Retroviral Agents.
- geographic , epidemiology : Uganda.
- complications : HIV Infections, Sarcoma, Kaposi.
- drug therapy : HIV Infections, Sarcoma, Kaposi.
- epidemiology : Sarcoma, Kaposi.
- statistics & numerical data : Outcome Assessment (Health Care).
- Adolescent, Adult, CD4 Lymphocyte Count, Epidemics, Female, Humans, Incidence, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Sex Factors, Young Adult.
Abstract
The incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda.
HIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to “improvement”, as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm3; IQR 11–156 cells/mm3) than men (124 cells/mm3; IQR 22–254 cells/mm3) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis.
The clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.
Url:
DOI: 10.1371/journal.pone.0013936
PubMed: 21103057
PubMed Central: 2980479
Affiliations:
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Le document en format XML
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Hutchinson Cancer Research Center, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author><author><name sortKey="Ssewankambo, Fred" sort="Ssewankambo, Fred" uniqKey="Ssewankambo F" first="Fred" last="Ssewankambo">Fred Ssewankambo</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Infectious Diseases Institute, Kampala, Uganda</addr-line></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Infectious Diseases Institute, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Nguyen, Huong" sort="Nguyen, Huong" uniqKey="Nguyen H" first="Huong" last="Nguyen">Huong Nguyen</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Saracino, Misty" sort="Saracino, Misty" uniqKey="Saracino M" first="Misty" last="Saracino">Misty Saracino</name><affiliation wicri:level="4"><nlm:aff id="aff2"><addr-line>Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Laboratory Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Wald, Anna" sort="Wald, Anna" uniqKey="Wald A" first="Anna" last="Wald">Anna Wald</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff2"><addr-line>Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Laboratory Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Department of Epidemiology, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author><author><name sortKey="Corey, Lawrence" sort="Corey, Lawrence" uniqKey="Corey L" first="Lawrence" last="Corey">Lawrence Corey</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff2"><addr-line>Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Laboratory Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author><author><name sortKey="Orem, Jackson" sort="Orem, Jackson" uniqKey="Orem J" first="Jackson" last="Orem">Jackson Orem</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Uganda Cancer Institute, Kampala, Uganda</addr-line></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Uganda Cancer Institute, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>College of Health Sciences, Makerere University, Kampala, Uganda</addr-line></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>College of Health Sciences, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Kambugu, Andrew" sort="Kambugu, Andrew" uniqKey="Kambugu A" first="Andrew" last="Kambugu">Andrew Kambugu</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Infectious Diseases Institute, Kampala, Uganda</addr-line></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Infectious Diseases Institute, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Casper, Corey" sort="Casper, Corey" uniqKey="Casper C" first="Corey" last="Casper">Corey Casper</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Medicine, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Department of Epidemiology, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff4"><addr-line>Department of Global Health, University of Washington, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health, University of Washington, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Anti-Retroviral Agents (therapeutic use)</term><term>CD4 Lymphocyte Count</term><term>Epidemics</term><term>Female</term><term>HIV Infections (complications)</term><term>HIV Infections (drug therapy)</term><term>Humans</term><term>Incidence</term><term>Kaplan-Meier Estimate</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Outcome Assessment (Health Care) (statistics & numerical data)</term><term>Proportional Hazards Models</term><term>Sarcoma, Kaposi (complications)</term><term>Sarcoma, Kaposi (drug therapy)</term><term>Sarcoma, Kaposi (epidemiology)</term><term>Sex Factors</term><term>Uganda (epidemiology)</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse multivariée</term><term>Antirétroviraux (usage thérapeutique)</term><term>Estimation de Kaplan-Meier</term><term>Facteurs sexuels</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Infections à VIH ()</term><term>Infections à VIH (traitement médicamenteux)</term><term>Jeune adulte</term><term>Modèles de hasards proportionnels</term><term>Modèles logistiques</term><term>Mâle</term><term>Numération des lymphocytes CD4</term><term>Ouganda (épidémiologie)</term><term>Sarcome de Kaposi ()</term><term>Sarcome de Kaposi (traitement médicamenteux)</term><term>Sarcome de Kaposi (épidémiologie)</term><term>Épidémies</term><term>Évaluation de résultat (soins) ()</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Uganda</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>HIV Infections</term><term>Sarcoma, Kaposi</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term><term>Sarcoma, Kaposi</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Sarcoma, Kaposi</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Outcome Assessment (Health Care)</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term><term>Sarcome de Kaposi</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antirétroviraux</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Ouganda</term><term>Sarcome de Kaposi</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>CD4 Lymphocyte Count</term><term>Epidemics</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Kaplan-Meier Estimate</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Proportional Hazards Models</term><term>Sex Factors</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse multivariée</term><term>Estimation de Kaplan-Meier</term><term>Facteurs sexuels</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Infections à VIH</term><term>Jeune adulte</term><term>Modèles de hasards proportionnels</term><term>Modèles logistiques</term><term>Mâle</term><term>Numération des lymphocytes CD4</term><term>Sarcome de Kaposi</term><term>Épidémies</term><term>Évaluation de résultat (soins)</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ouganda</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>The incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda.</p></sec><sec><title>Methods and Findings</title><p>HIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to “improvement”, as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm<sup>3</sup>; IQR 11–156 cells/mm<sup>3</sup>) than men (124 cells/mm<sup>3</sup>; IQR 22–254 cells/mm<sup>3</sup>) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis.</p></sec><sec><title>Conclusions</title><p>The clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Onyango, Jf" uniqKey="Onyango J">JF Onyango</name></author><author><name sortKey="Njiru, A" uniqKey="Njiru A">A Njiru</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Parkin, Dm" uniqKey="Parkin D">DM Parkin</name></author><author><name sortKey="Wabinga, H" uniqKey="Wabinga H">H Wabinga</name></author><author><name sortKey="Nambooze, S" uniqKey="Nambooze S">S Nambooze</name></author><author><name sortKey="Wabwire Mangen, F" uniqKey="Wabwire Mangen F">F Wabwire-Mangen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wabinga, Hr" uniqKey="Wabinga H">HR Wabinga</name></author><author><name sortKey="Parkin, Dm" uniqKey="Parkin D">DM 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uniqKey="Johnston C">C Johnston</name></author><author><name sortKey="Orem, J" uniqKey="Orem J">J Orem</name></author><author><name sortKey="Okuku, F" uniqKey="Okuku F">F Okuku</name></author><author><name sortKey="Kalinaki, M" uniqKey="Kalinaki M">M Kalinaki</name></author><author><name sortKey="Saracino, M" uniqKey="Saracino M">M Saracino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yoo, D" uniqKey="Yoo D">D Yoo</name></author><author><name sortKey="Lee, K" uniqKey="Lee K">K Lee</name></author><author><name sortKey="Munderi, P" uniqKey="Munderi P">P Munderi</name></author><author><name sortKey="Sin, K" uniqKey="Sin K">K Sin</name></author><author><name sortKey="Lee, J" uniqKey="Lee J">J Lee</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ouganda</li><li>États-Unis</li></country><region><li>Washington (État)</li></region><settlement><li>Seattle</li></settlement><orgName><li>Université de Washington</li></orgName></list><tree><country name="États-Unis"><region name="Washington (État)"><name sortKey="Phipps, Warren" sort="Phipps, Warren" uniqKey="Phipps W" first="Warren" last="Phipps">Warren Phipps</name></region><name sortKey="Casper, Corey" sort="Casper, Corey" uniqKey="Casper C" first="Corey" last="Casper">Corey Casper</name><name sortKey="Casper, Corey" sort="Casper, Corey" uniqKey="Casper C" first="Corey" last="Casper">Corey Casper</name><name sortKey="Casper, Corey" sort="Casper, Corey" uniqKey="Casper C" first="Corey" last="Casper">Corey Casper</name><name sortKey="Casper, Corey" sort="Casper, Corey" uniqKey="Casper C" first="Corey" last="Casper">Corey Casper</name><name sortKey="Corey, Lawrence" sort="Corey, Lawrence" uniqKey="Corey L" first="Lawrence" last="Corey">Lawrence Corey</name><name sortKey="Corey, Lawrence" sort="Corey, Lawrence" uniqKey="Corey L" first="Lawrence" last="Corey">Lawrence Corey</name><name sortKey="Corey, Lawrence" sort="Corey, Lawrence" uniqKey="Corey L" first="Lawrence" last="Corey">Lawrence Corey</name><name sortKey="Nguyen, Huong" sort="Nguyen, Huong" uniqKey="Nguyen H" first="Huong" last="Nguyen">Huong Nguyen</name><name sortKey="Phipps, Warren" sort="Phipps, Warren" uniqKey="Phipps W" first="Warren" last="Phipps">Warren Phipps</name><name sortKey="Saracino, Misty" sort="Saracino, Misty" uniqKey="Saracino M" first="Misty" last="Saracino">Misty Saracino</name><name sortKey="Wald, Anna" sort="Wald, Anna" uniqKey="Wald A" first="Anna" last="Wald">Anna Wald</name><name sortKey="Wald, Anna" sort="Wald, Anna" uniqKey="Wald A" first="Anna" last="Wald">Anna Wald</name><name sortKey="Wald, Anna" sort="Wald, Anna" uniqKey="Wald A" first="Anna" last="Wald">Anna Wald</name><name sortKey="Wald, Anna" sort="Wald, Anna" uniqKey="Wald A" first="Anna" last="Wald">Anna Wald</name></country><country name="Ouganda"><noRegion><name sortKey="Ssewankambo, Fred" sort="Ssewankambo, Fred" uniqKey="Ssewankambo F" first="Fred" last="Ssewankambo">Fred Ssewankambo</name></noRegion><name sortKey="Kambugu, Andrew" sort="Kambugu, Andrew" uniqKey="Kambugu A" first="Andrew" last="Kambugu">Andrew Kambugu</name><name sortKey="Orem, Jackson" sort="Orem, Jackson" uniqKey="Orem J" first="Jackson" last="Orem">Jackson Orem</name><name sortKey="Orem, Jackson" sort="Orem, Jackson" uniqKey="Orem J" first="Jackson" last="Orem">Jackson Orem</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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