title: Inguinal lymph node and anorectal mucosal biopsies for human immunodeficiency virus research protocols in an emerging nation: patient outcomes and lessons learned.
abstract: BACKGROUND
  Lymph nodes and gut-associated lymphatic tissue are important reservoirs of the human immunodeficiency virus (HIV). Little is known about these reservoirs in different geographic populations. We report the surgical outcomes of excisional lymph node and anorectal mucosal biopsies performed internationally and describe the lessons learned.
  
  
  METHODS
  Patients were recruited through the Joint Clinical Research Center (JCRC) in Kampala, Uganda, where procedures were performed. Studies were approved by the Institutional Review Boards of the JCRC and the University of Minnesota. Instruments and supplies were shipped to Uganda and prepared onsite. Drugs and skin preparations were purchased locally. Lymph nodes were removed through 1-3 cm incisions with ligatures on lymphovascular pedicles. Incisions were closed with subcuticular sutures and epidermal tape. Two to four pieces of anorectal mucosa were obtained through anoscopes using biopsy forceps.
  
  
  RESULTS
  One hundred thirty-eight lymph node biopsies and 98 anorectal mucosal biopsies were performed on 71 patients. Forty-one patients were HIV-positive. Many patients had multiple procedures. Two minor complications resulted: One hematoma and one lymphocele. Despite the cost of travel and lodging, cost per biopsy was lower in Uganda compared with the United States.
  
  
  CONCLUSIONS
  Invasive clinical research can be performed with minimal morbidity in emerging nations with outcomes similar to those found in the United States, but with lower cost.
authors: 1 University of Minnesota , Minneapolis, Minnesota.
authors: Meghan K
authors: MK
authors: Rothenberger
authors: C Kityo
authors: CK
authors: Mutuluuza
authors: F
authors: F
authors: Ssali
authors: Jake
authors: J
authors: Jasurda
authors: Thomas
authors: T
authors: Schmidt
authors: Timothy W
authors: TW
authors: Schacker
authors: Greg J
authors: GJ
authors: Beilman
authors: Jeffrey G
authors: JG
authors: Chipman
mesh_terms: D000293:Adolescent; D000328:Adult; D035843:Biomedical Research / Q000191:economics / Q000379:methods*; D001706:Biopsy / Q000191:economics / Q000379:methods*; D003906:Developing Countries; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology*; D017048:Health Care Costs; D006801:Humans; D007413:Intestinal Mucosa / Q000821:virology*; D008198:Lymph Nodes / Q000821:virology*; D008297:Male; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult
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