Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:2.7.10.2 (focal adhesion kinase)
 44,029 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Epidemiologic studies in Nairobi and elsewhere in Africa, have shown that men infected with HIV-1 more commonly have a history of genital ulcer disease compared to uninfected men. In one study, HIV infected men were three times as likely to have a recent history of genital ulcers. In a prospective study of seronegative men, those presenting with chancroid had a five-fold risk of seroconversion during follow-up compared to men presenting with urethritis. Uncircumcised men had an increased risk of seroconversion which was independent of their risk of genital ulcer disease. Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin. Genital ulcers are a major risk factor for HIV infection among prostitutes. The increased risk is about 10-fold among prostitutes with ulcers compared to a cohort who did not. We hypothesize from these studies that genital ulcers are the major portals of entry for HIV infection and also increased shedding of virus infected cells into the vaginal secretions. HIV seropositive prostitutes are more susceptible to chancroid with a two-fold increase in the prevalence of genital ulcers as compared to HIV negative women. The use of condoms by their clients prevents both genital ulcer disease and HIV acquisition among prostitutes. Chancroid is more difficult to treat in HIV infected men with one-third of patients failing single dose treatment regimens as compared to less than five percent of men without HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission. 226 93

The 1st generation of serological tests for anti-HIV-1 gave so many false positives with African sera that it was wrongly postulated that the virus was endemic in Africa. As there is no simian or other virus sufficiently closely related to HIV-1 as to suggest a recent common ancestor, the evolution of HIV-1 is obscure and there is no evidence to support the hypothesis of an African origin. However, the similarity of HIV-2 to SIV and its geographical distribution do suggest an evolution of this virus in west Africa. The earliest anti-HIV-1 positive serum was from a subject in Kinshasa in 1959. Seroprevalence rose in pregnant women in Kinshasa from 0.25% in 1970 to 3.0% in 1980 and 5.7% in 1986. When 2 sexually promiscuous groups are compared, seropositivity rose sharply in female prostitutes in Nairobi from 4% in 1981 to 59% in 1984 and 64% in 1986, a curve which is approximately parallel to, but 3 years later than that of homosexual males in San Francisco. In central and east Africa, HIV-1 is now epidemic from Congo to Kenya and from Uganda to Zimbabwe. In west Africa, both HIV-2 and HIV-1 are epidemic; seroprevalence of HIV-2 is highest in southern Senegal, Guinea-Bissau, and Cote d'Ivoire: HIV-1 had the highest frequency in Cote d'Ivoire and Ghana. HIV-2 has not been reported, and HIV-1 is pre-epidemic in Africa north of the Sahara, Nigeria, Angola, MOzambique, and southern Africa, being found at significant frequency only in female prostitutes, patients with STD, or, in Morocco and South Africa only, in male homosexuals. Seroprevalence is greatest in female prostitutes and patients with STD; infection is more frequent in urban than in rural populations, except in Uganda. The peak frequency is at 30-34 years in males and 20-24 years in females. Other groups at risk are infants born to infected mothers, and those requiring blood transfusions, especially preschool children, patients with sickle cell disease, and pregnant women. The doubling time for seropositivity is about 1 year in the sexually active age range in some populations. Even at existing seroprevalence, decimation or worse of the most productive age groups is inevitable during the next few years in certain countries. Accelerated progression of the disease during pregnancy will lead to higher morbidity and mortality among fertile women than among men. The recent reductions in infant and childhood mortalities will be reversed, and populations may decline. Devastating social, economic, and demographic consequences are forecast. (author's)
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PMID:Seroepidemiology of human immunodeficiency viruses in Africa. 319 Dec 7

Sexual behaviour in Kenya in relation to STD transmission was investigated with a view to forming a basis for the more rational design of STD/HIV control interventions. Questionnaires were administered to a sample of 762 men and women attending eight health facilities in two urban centres. Equal numbers of STD patients (cases) and non-STD related clinic attenders (clinic controls) were selected, matched by gender and clinic. Another sample of 427 men and women was obtained from a random sampling of households in a slum area in Nairobi (community controls). Male STD patients who were unmarried, or married but living apart from their wives, reported a higher mean number of sex partners in the previous three months than did male clinic or community controls. Unmarried female STD patients reported a higher mean number of sex partners in the previous three months than did unmarried female clinic or community controls. Both male and female STD patients were more likely to report having been involved in commercial sex transactions in the previous three months than clinic or community controls. Considerable heterogeneity in sexual behaviour was apparent. In multivariate analysis, the most important predictor of STD acquisition for both men and women was the number of reported sex partners in the previous three months. In addition, for men only, marital status (unmarried, or married but living apart from their wives) and purchasing sex were significant predictors of being an STD patient. These data confirm the importance of commercial sex in STD transmission, and suggest that men play a bridging role between female sex workers and the general population of women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sexual behaviour in Kenya: implications for sexually transmitted disease transmission and control. 784 62

In order to determine knowledge of HIV transmission, sexual risk behaviour and perception of risk in African health care workers, 200 employees at the Aga Khan Hospital, Nairobi, Kenya, were asked to complete an anonymous self-administered questionnaire. There was a 75% response rate. Twenty-five per cent believed that condoms were not protective against HIV transmission. Eighty-nine per cent believed oral sex to be a risk factor, as did 70% for kissing, 41% for masturbation of a partner and 43% for nursing an AIDS patient. Younger people were more likely to think condoms were ineffective (P = 0.007) and that insect bites were a significant risk factor (P = 0.004). Twenty-seven per cent had changed their sexual behaviour as a result of the AIDS epidemic, but 48% did not use condoms with non-regular partners. Four had current or previous homosexual relationships. Seventy per cent believed they were at risk of being HIV positive but only 12% had been tested. We have shown that even in the educated group, misconceptions regarding HIV transmission were high and many continue to be at risk for their sexual behaviour. In addition, in-service training regarding HIV transmission should be considered for health care workers in Africa.
Int J STD AIDS
PMID:Knowledge of HIV transmission and risk behaviour in Kenyan health care workers. 839 98

This pilot study aimed to determine the feasibility of a larger study of contraception and risk of HIV infection in women. We also measured risk factors for and occurrence of HIV infection in the participants. A cohort of 1537 seronegative women attending a family planning clinic in Nairobi, Kenya was enrolled and followed for up to 12 months per woman. HIV testing was done quarterly. A nested case-control analysis was done with seroconverting women (cases) and 3 matched controls per case, who had detailed interviews and received physical examinations and STD tests. The prevalence of HIV at enrollment was 6.1%; seropositive women were excluded from further analysis. The 12-month life-table cumulative incidence of HIV was 2.1 per 100 women (95% confidence interval [CI] 1.1-3.2). In the nested case-control analysis (17 cases and 51 controls), the crude odds ratio of HIV infection comparing oral contraceptive (OC) users with other women was 3.5 (95%) CI 0.8-21.5), which persisted after control for single confounders at a time. The putative association between OC use sand HIV infection is critical to public health policy, yet no study has been conducted specifically to measure it, yielding weak and conflicting evidence. We intend to conduct a larger study with a similar design as the current pilot study, which confirmed the feasibility of a more definitive project.
Int J STD AIDS
PMID:Contraceptive use and HIV infection in Kenyan family planning clinic attenders. 865 17

A randomized, comparative study undertaken in Nairobi, Kenya and a non-comparative evaluation undertaken in Carletonville, South Africa have both shown that a single oral dose of azithromycin 1 g is effective in the treatment of the genital ulcer disease (GUD), chancroid, with cure rates of 89% and 92% recorded respectively. While treatment failure was associated with human immunodeficiency virus seropositivity and lack of circumcision in Kenya, no such association could be found in the South African study. In both series, azithromycin treatment resulted in cure of both Haemophilus ducreyi culture-positive and culture-negative cases of GUD, including two cases subsequently diagnosed as lymphogranuloma venereum. A combination of single-dose azithromycin with single-dose benzathine penicillin may provide effective 'single-visit' syndromic treatment for GUD in many developing countries.
Int J STD AIDS 1996
PMID:Treatment of chancroid with azithromycin. 865 28

Male patients (mean age, 28 years) attending a sexually transmitted disease clinic in Nairobi, Kenya, for either urethritis (276 controls) or a genital ulcer (607 cases) were compared with respect to sexual behavior, presence of HIV-1 antibody, and circumcision status. Only 164 men were not circumcised. Circumcised men reported more life-time sex partners than uncircumcised men (19 vs. 10, p 0.01). Patients were followed up for 196 days to explore the risk factors for incident genital ulcers and HIV-1 seroconversion. On average, 2.66 follow-up visits per patient were recorded. 28 men seroconverted to HIV-1 during follow-up. 61% of the ulcer patients reported sex workers as the likely source of their infection, whereas 58% of the urethritis patients did so. Multiple logistic regression variables of marital status, age, and genital ulcer in the past were used to examine the relationship among these variables. Ulcer in the past was a significant predictor of a current ulcer (p 0.01) and higher age was significantly associated with HIV-1 seropositivity (p 0.01). At entry, being married was associated with higher prevalence of HIV-1 (odds ratio [OR] = 1.76) and genital ulcers (OR = 1.42). Lack of circumcision was associated with both HIV-1 infection (OR = 4.67) and the presence of a genital ulcer (OR = 2.3). 68 men acquired a new ulcer during follow-up. HIV-1 seropositivity at enrolment was significantly associated with genital ulcer reinfection (relative risk = 3.63 by Cox's regression). Genital ulcers were also associated with HIV-1 infection (OR = 1.87) independent of circumcision status. On follow-up, HIV-1 seropositivity was associated with incident genital ulcers. The association between genital ulcers and HIV-1 infection may be more complex than ulcers' simply being a risk factor for HIV-1 infection: either HIV-1 infection may increase the risk of acquiring a genital ulcer or HIV-1 infection and genital ulcers may have some unknown risk factor in common.
Int J STD AIDS 1996 Oct
PMID:Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status. 894 Jun 69

Of 22,274 patients > or = 12 years old attending a Nairobi primary health care (PHC) clinic, 1076 (4.8%) had STD-related complaints, of whom 980 underwent assessment of risk factors for human immunodeficiency virus (HIV) infection and infrequent condom use. Gonorrhoea, chancroid, syphilis seroactivity, trichomoniasis, or objective signs of STD were found in 78%, and HIV seropositivity in 15% of men and 19% of women. Most women were married, living with a spouse; while most men were single, or married, but living separated from a spouse. Among married men, last sex was with a female sex worker (FSW) or casual partner for 60% not living with a spouse and 26% living with a spouse (P<0.005). Two or more partners during the past year were reported by 82% of men and 25% of women (P <0.001), and 55% of men and 11% of women reported the last partner was high risk. HIV seropositivity among both genders was associated with numbers of partners, and among women, with being widowed or divorced. Only 3% reported use of a condom with the last partner. Among men whose last sex was with a FSW, 74% said the reason for not using a condom was not having one. Thus, infrequent condom use, low condom availability, and gender differences in behaviour necessitate modifying development policies that separate families; and better coordination between family planning, PHC, and AIDS/STD programmes, with improved supply, social marketing and community-based distribution of condoms in high-risk settings for STD/HIV prevention.
Int J STD AIDS 1997 Aug
PMID:High HIV prevalence, low condom use and gender differences in sexual behaviour among patients with STD-related complaints at a Nairobi primary health care clinic. 925 99

Chancroid is caused by infection with Hemophilus ducreyi, and is associated with an increased risk for the sexual transmission of HIV-1. The authors assessed whether the clinical and histological features of chancroid are changed by HIV infection, using 320 male patients who presented during February-November 1994 to the City of Nairobi Special Treatment Clinic with a clinical diagnosis of chancroid. 109 subjects were HIV seropositive and 211 were HIV seronegative. A detailed history, physical examination, swabs for Hemophilus ducreyi culture and blood for HIV serology, syphilis serology, and CD4 counts were obtained from all patients. Punch biopsies from an ulcer were obtained from 10 patients and either fixed in 10% formalin or snap frozen in Optimum Cutting Temperature (OCT) medium compound at -70 degrees Celsius. Patients were treated with erythromycin and followed for 3 weeks. HIV patients had ulcers of longer duration than did HIV-seronegative patients. Although cure rates were similar at 3 weeks, HIV patients had lower cure rates at 1 week (23% vs. 54%). A dense interstitial and perivascular inflammatory infiltrate extending from the reticular to deep dermis was present in all biopsies. The infiltrate consisted of equal amounts of CD4 and CD8 T-lymphocytes as well as macrophages. The histological and immunohistochemical picture was identical for HIV-positive and HIV-negative patients. Study findings therefore indicate that HIV infection slows the healing rates of chancroid ulcers despite appropriate antibiotic therapy. The clinical difference cannot be attributed to an altered histopathological response to HIV infection.
Int J STD AIDS 1998 Sep
PMID:Clinical and in situ cellular responses to Haemophilus ducreyi in the presence or absence of HIV infection. 976 37

This study presents the trend in syphilis prevalence among 81,311 pregnant women in Nairobi, Kenya, from 1994 to 1997. Clinic nurses performed syphilis serology using a rapid plasma reagin (RPR) card test in 10 NCC clinics and Chi square; these were used to study trends over time. Results showed that a total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7-7.7) in 1994, 7.3% (95% CI: 6.9-7.7) in 1995, 4.5% (95% CI: 4.3-4.8) in 1996, and 3.8% (95% CI: 3.6-4.0) in 1997. Thus, a significant decrease in syphilis seroprevalence among pregnant women in Nairobi was observed since 1995-96, by contrast with the rising trend in syphilis prevalence reported in 1990 and 1994-95 in the same population. This decline was attributable in large part to the syphilis control program initiated in Nairobi in June 1992, which focused on sexual behavior modifications, changes in health care seeking behavior and improved health care services.
Int J STD AIDS 1999 Jun
PMID:Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field? 1041 84


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