Gene/Protein Disease Symptom Drug Enzyme Compound
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The aim of the study was to describe survival patterns of Southern Brazilian AIDS patients: 224 predominantly working class AIDS patients were treated in an AIDS referral centre in Porto Alegre between October 1986 and September 1991. The caseload increased progressively, as did the number of female AIDS cases treated at the Hospital during the study period. Self-referred patients were more likely to present with an AIDS defining condition (P < 0.03) and they (n = 106) had significantly worse survival patterns compared with patients referred by other health care professionals (n = 112; P < 0.04). Median survival from the time of AIDS diagnosis was 5 months which did not change significantly during the study period (P = 0.38). Patients (n = 42) presenting with opportunistic infections other than mycobacterial disease (n = 42), Pneumocystis carinii pneumonia (n = 37) or candidiasis (n = 18), had significantly worse survival patterns (P = 0.001). Patients treated with zidovudine (n = 33) survived significantly longer from time of AIDS diagnosis than those not on zidovudine (n = 185; P = 0.0002). No significant survival differences were observed from time of AIDS diagnosis between those who commenced on zidovudine before developing AIDS (n = 17) and those who were treated with zidovudine since diagnosed with AIDS (n = 16; P = 0.80). During the study period zidovudine was only available through private prescriptions. Survival of Southern Brazilian AIDS patients has not improved: earlier access to HIV-related services and the provision of effective and affordable therapeutic interventions are two measures which could improve future survival patterns.
Int J STD AIDS
PMID:Survival and medical intervention in southern Brazilian AIDS patients. 794 59

Of 6125 women attending an STD clinic from 1988 to 1991, 5365 (88%) were tested for vaginitis of whom 97 (1.8%) had trichomoniasis, 945 (17.6%) had candidiasis, 734 (13.7%) had bacterial vaginosis and 3628 (67.6%) were free of vaginal infection. Dual infections occurred in 49 (0.9%) patients. Independent predictors for trichomoniasis by multivariate analysis were being pregnant (odds ratio (OR) = 2.4), having vaginal discharge or dysuria (OR = 4.7), being Aboriginal (OR = 4.3), being Asian (OR = 5.0), being unemployed (OR = 2.1) or tattoed (OR = 1.9). Many factors, including use of oral contraception (OR = 1.2) and current antibiotic medication (OR = 1.5), had a small significant association with candidiasis. Independent predictors for bacterial vaginosis were having multiple sex partners in the past month (OR = 1.6), being unmarried (OR = 1.5), being unemployed (OR = 1.3) being a prostitute (OR = 1.5) and not currently using antibiotic medication (OR = 2.5). The epidemiological profiles were consistent with trichomoniasis and bacterial vaginosis being sexually transmitted diseases with epidemiology different from that of gonorrhoea and chlamydia and different from each other, and candidiasis being a disease in which constitutional factors are more important than issues relating to sexual transmission.
Int J STD AIDS
PMID:Factors associated with trichomoniasis, candidiasis and bacterial vaginosis. 842 98

Medical professionals in countries with only poor and limited laboratory facilities often must diagnose diseases solely upon the basis of clinical manifestations. In an attempt to facilitate the surveillance of AIDS in developing countries, the World Health Organization (WHO) recommended criteria for the clinical case definition of AIDS in adults and children. Preliminary examination of children in Zambia, however, found that a number of patients with obvious AIDS did not fit the published WHO case definition for pediatric AIDS. The Zambia National AIDS Surveillance Committee therefore subsequently designed local criteria for the clinical case definition of pediatric AIDS. This paper presents findings from a comparison of the Zambian criteria with the WHO criteria for the diagnosis of pediatric AIDS. Major signs of pediatric AIDS in the WHO clinical case definition are weight loss or abnormally slow growth, chronic diarrhea of more than one month's duration, and prolonged fever of more than one month's duration, while the major signs in the Zambian clinical criteria are recurrent fever of at least one month's duration, recurrent oropharyngeal candidiasis, and recurrent respiratory infections. 134 consecutively admitted children to one of the pediatric wards at the University Teaching Hospital in Lusaka were studied. The FUJIREBIO particle agglutination test, ELISA, and Western blot tests found 29 patients to be HIV-1-seropositive and 105 to be HIV-1-seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23 and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria. These results indicate a sensitivity, specificity, and positive predictive value of 79.3%, 91.4%, and 86.8%, respectively, for the Zambian criteria for the diagnosis of AIDS, compared to 69%, 64%, and 38%, respectively, for the WHO criteria. The authors conclude that current WHO criteria are inadequate for the diagnosis of pediatric AIDS, and discuss the need to refine the WHO criteria for that diagnosis.
Int J STD AIDS
PMID:Case definitions for paediatric AIDS: the Zambian experience. 847 70

Visceral candidiasis is nonspecific in the clinical presentation and a microbiological diagnosis is often difficult to make. Currently, several techniques are available for detection of the antigen and antibody and/or fungal product. We report the results of an investigation in immunodiagnosis and blood biochemical diagnosis of visceral candidiasis and suggest the cutoff limits of positive, from these findings and those reported by others. The efficiency and specificity were 36.4% approximately 60% and 94% approximately 100% for the mannan detection kit from Kyokuto Co., Ltd. and 57.1% approximately 100% and 25% approximately 69.6% for the CAND-TEC, and 28.6% and 91.7% for PASTOREX CANDIDA. For kits using a blood biochemical assay; the efficiency and specificity were 10% approximately 56.7% and 91.4% approximately 100% with detection of D-arabinitol (cutoff limits; 20 mumol/ml < or =), and 70% approximately 75% and 91.7% approximately 100% for Fungal Index (cutoff limits; 60pg/ml < or =). We investigated the evaluation of LA test to detect candidal mannan antigen in sera obtained from experimental gastric candidiasis of mice with or without treatment. There was a good correlation between the change of the titer of mannan antigen and the severity of infections, and gastric lesions healed histopathologically 3 weeks after disappearance of mannan antigen in sera obtained from mice treated with an antifungal agent. These findings indicate that the antifungal therapy is necessary for more than 3 weeks after the candidal mannan antigen disappeared from sera.
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PMID:[Immunodiagnosis and blood biochemical diagnosis of visceral candidiasis and the cutoff limits of positive]. 875 26

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of childbearing age. In some women it shows a relapsing and remitting course with apparently spontaneous onset and resolution. There are intermediate patterns of vaginal flora in which lactobacilli and other species co-exist. We asked women with recurrent BV to prepare vaginal smears daily, and to record symptoms, time of menstruation, sexual activity and use of douches or medication. We Gram-stained the smears and assigned a Nugent score for BV, and noted the presence of candida, pus cells, sperm and blood. Eighteen women collected daily vaginal smears for up to 10 months. Forty months of slides were collected in total. Bacterial vaginosis arose spontaneously on 23 occasions. We saw candida arise 11 times. Bacterial vaginosis appeared after candida on 9 of these 11 episodes. We saw BV regress spontaneously 13 times. Nine of these resolutions occurred within 48 h of unprotected sexual intercourse: BV only arose on one occasion within 48 h of unprotected intercourse. The intermediate pattern was seen for up to 10 days, and occurred as BV began or resolved in some women, and sometimes resolved without developing into BV. Bacterial vaginosis arose most often in the first 7 days of a menstrual cycle, and resolved spontaneously most often in mid-cycle. In women with recurrent BV, BV arises most often around the time of menstruation and resolves spontaneously in mid-cycle. Recurrences often follow an episode of candidiasis, and BV often regresses after unprotected sexual intercourse.
Int J STD AIDS 1997 Oct
PMID:Sex, thrush and bacterial vaginosis. 931 Feb 18

A detailed assessment was completed on 150 consecutive new female patients attending a walk-in genitourinary medicine clinic, in order to elicit the features of vulval pain. Twenty patients (13.3%) experienced vulval pain, and of these, 15 (75%) had an infective cause demonstrated. Candidiasis was demonstrated in more than half (55%) of them and one-fifth had genital herpes. Of the 5 patients in whom no infection was present, 2 were diagnosed with the vulvar vestibulitis syndrome (VVS) following their referral to the dedicated vulval clinic.
Int J STD AIDS 1998 Feb
PMID:Prevalence, causes and outcome of vulval pain in a genitourinary medicine clinic population. 950 73

A retrospective review of AIDS-related oesophageal candidiasis was undertaken to identify clinical features helpful in predicting response to azole therapy and patient survival. Patients who had received daily azole prophylaxis against candidiasis were significantly less likely to respond to azole therapy than those who had not (P < 0.001). Patients who had lost > 5% of their body weight in the 2 months before oesophageal candidiasis were less likely to respond to azoles than the others (P < 0.001). Amongst those who had not received daily azoles, patients with a CD4+ cell count < 25/mm3 were less likely to respond to azole treatment (P = 0.05). The median survival beyond oesophageal candidiasis was 18 months. Survival from oesophageal candidiasis was significantly poorer for patients who did not respond to azole therapy but AIDS survival did not differ between azole responders and non-responders. Non-responders who had been taking daily azole prophylaxis had the poorest survival (median = 4 months).
Int J STD AIDS 1998 Jan
PMID:Clinical predictors of azole resistance, outcome and survival from oesophageal candidiasis in AIDS patients. 951 9

Findings are reported from a study conducted to assess the prevalence of sexually transmitted infections, including HIV, among female prostitutes working at truckstops in the KwaZulu-Natal midlands of South Africa. The 145 participating prostitutes were recruited from 5 truckstops along the major national road between Durban and Johannesburg from August 1996 to March 1997. Their mean age was 25 years and they had been prostitutes for an average of 3 years. A gynecologic examination was performed upon each woman, including a speculum examination, and investigations were also conducted to identify gonorrhea, syphilis, chlamydia, candidiasis, trichomoniasis, bacterial vaginosis, and HIV infection. The examinations found that 50.3% of the women were HIV seropositive, 41.3% were infected with Trichomonas vaginalis, 40.6% had Candida albicans, 14.3% had Neisseria gonorrheae, 16.4% had Chlamydia trachomatis, 71% had bacterial vaginosis, and 42.1% had active syphilis. These findings point to the need for HIV/STD prevention interventions among both the prostitutes and their clients.
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PMID:Sexually transmitted infections among sex workers in KwaZulu-Natal, South Africa. 971 13

Vulvovaginal candidiasis is a frequent inflammatory process in women but it has not been widely studied in female sex workers (FSWs). To estimate the frequency of Candida species infection in FSWs and to identify related risk factors and clinical findings, we carried out a retrospective study of 1923 FSWs over 11 years. We also performed a prospective study of 163 consecutive FSWs with a history of candidiasis during a 4-year period. Candida species were isolated in 1967 samples (18.5% of the total). Candida albicans (89.3%) was the most frequent species, followed by Candida glabrata (2.7%), Candida parapsilosis (1.2%) and Saccharomyces cerevisiae (0.4%). In the prospective study of 163 patients, we found vaginal discharge in 76.1% of cases, soreness in 52.1% and vulval pruritus in 32.5%. We identified 12 patients (7.4%) with recurrent vulvovaginal candidiasis. No statistical difference was found between recurrent vulvovaginitis and the use of oral contraceptives, oral sex, tight-fitting clothing and synthetic underwear. FSWs have the same prevalence of candidiasis as other groups of women described in published literature. The proportion of albicans and non-albicans species does not differ between women with recurrent and non-recurrent vulvovaginal candidiasis (VVC).
Int J STD AIDS 1998 Sep
PMID:Vulvovaginal candidiasis in female sex workers. 976 36

The pandemic impact of HIV has changed the clinical spectrum of STDs all over the world. The incidence and frequency of STDs in the different global geographic areas demonstrate the diagnostic and treatment capabilities of various local and national health systems and is simultaneously informing about the sexual behaviours of the population. The purpose of this study was to determine the frequency of curable STDs (herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis) in a hospital-based STD clinic in Madrid, Spain during a 4-year period. Patients were referred mainly from the emergency department, gynecological wards, and family planning (61%) as well as from the HIV-hospital unit (31 beds) and outpatient department (39%). The total number of patients seen was 952 (243 men, 709 women) with an annual average of 238 patients per year. Of these, 139 (14.6%) were HIV-patients and 813 (85.4%) non-HIV patients. In non-HIV patients, STDs were identified in 493 cases (54.2%). In HIV-patients, STDs were diagnosed in 108 cases (77.7%; p < or = 0.001). Two or more STDs were more prevalent in HIV than non-HIV patients. The frequency of STDs in both HIV and non-HIV patients were vulvovaginal candidiasis, 47.8%:57.2%; syphilis, 11.7%:1.4% (p < or = 0.05); gonorrhea, 5.3%:3.9%; Gardnerella vaginosis, 6.3%:4.8%; genital chlamydia, 6.3%:9.06%; trichomoniasis, 17%:6.5% (p < or = 0.05); and genital herpes, 20.2%:5.3% (p < or = 0.05).
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PMID:Differences in curable STDs between HIV and non-HIV populations in Spain. 1037 65


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