Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.10.2 (focal adhesion kinase)
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A retrospective analysis of all culture-positive cases of Mycobacterium tuberculosis infection in HIV positive individuals, over a 5 year period, revealed 18 cases, drawn from a population of approximately 1500. The prevalence of culture proven M. tuberculosis over the 5 year period was therefore 1.2% and was strongly associated with either a concomitant, or a subsequent, AIDS diagnosis. Sixty-one per cent had pulmonary tuberculosis, 17% had both extra-pulmonary and pulmonary infection and 22% had extra-pulmonary infection alone. Although a wide range of radiological abnormalities was seen, segmental consolidation was the commonest, occurring in 57% of cases. Only 55% of the specimens were positive on initial stains for M. tuberculosis, with a mean duration of 4 weeks to become culture positive, emphasizing that early diagnosis rests on clinical suspicion.
Int J STD AIDS
PMID:Tuberculosis in HIV seropositive individuals--a retrospective analysis. 154 66

This is a study of Lesotho's proposal to United Nations agencies for financial assistance to build a medical school and a 600- bed referral teaching hospital. To qualify for such assistance, a feasibility study was prepared that included data from Lesotho's Ministries of Planning, Finance and Health on the following: 1) demography, including fertility; 2) health status and major health problems; 3) health facilities and health service utilization; 4) health manpower; and 5) health service organization, financing and cost. Lesotho's population was 1.37 million in 1981 growing at 2.3% per year. 13% of the population was urban, living in Maseru, the capital. Infant and child mortality rates are 116/1000 and 15.6/1000 while maternal mortality rates are 3.7/1000. The leading causes of death for children are malnutrition, acute respiratory and infectious diseases, gastrointestinal diseases and congenital anomalies. While adults are dying from tuberculosis, heart disease, injuries, burns and digestive diseases. Even though Lesotho's climate and high altitude insulate it from many diseases, there is concern over the high incidence of pulmonary tuberculosis, sexually transmitted diseases (STD's) and respiratory infections. In 1980 1/3 of the population has access to hospital care. Maseru had 40% of the hospital beds, yet only 4.4% of the population. In 1982 there were 1536 health workers employed by the Ministry of Health, of these 41 were doctors, 175 nurses and 132 nursing assistants. Instead of building a new medical school, Lesotho accepted renovating the existing general hospital, converting it into a national referral center, while introducing more specialties at 20% of the $US60 estimated for a new medical school. Recommendations to the government also included: 1) special programs aimed at reducing and controlling tuberculosis and STD's; 2) establishing and strengthening primary health care programs; and 3) decreasing long hospital stays. (author's modified).
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PMID:Getting the best value for money in health care. 261 Aug 47

Serum beta 2-microglobulin (beta 2M) rises in the later stages of HIV disease and has therefore been used to monitor progression to AIDS. However, little work has been done on patients co-infected with HIV and tuberculosis. We studied clinical features and serum beta 2-M in 35 Tanzanian patients treated for pulmonary tuberculosis (9 HIV-positive, 26 HIV-negative). The provisional WHO clinical definition of AIDS for use in Africa was fulfilled by 89% of the HIV-positive and 65% of the HIV-negative patients. Median serum beta 2-M on admission was slightly higher in HIV-positive (3.17 mg/l) than in HIV-negative (2.85 mg/l) patients. Serum beta 2-M fell during treatment in 17/24 (71%) of HIV-negative and 3/7 (43%) HIV-positive patients followed up for 6 months. We conclude that serum beta 2-M is frequently raised in active tuberculosis, and is therefore an unreliable indicator of the stage of HIV disease in co-infected patients. The WHO clinical definition of AIDS also proved unreliable in patients with tuberculosis.
Int J STD AIDS
PMID:Clinical features and serum beta 2-microglobulin levels in HIV-1 positive and negative Tanzanian patients with tuberculosis. 754 92

HIV-1 was first detected in India in 1986. HIV-2 was first detected in the country in 1991 when paid blood donors and STD clinic attenders in north India tested seropositive for the virus. HIV-2 was later detected in Bombay and Goa. HIV-2 was also introduced in Madras and followed by an exponential increase in 1992 where heterosexual transmission was found to be responsible for the spread of the virus. 433 blood samples were collected and screened during the second quarter of 1994 from blood donors, injecting drug users (IDUs), and clinically suspected HIV disease cases admitted to the Regional Medical College (RMC) Hospital or treated at the outpatient department. 60.5% of IDUs tested positive for HIV-1, 6.6% were infected with both HIV-1 and HIV-2, and none were found to be infected exclusively with HIV-2. HIV-infected IDUs were aged 15-35 years and exclusively male. Most clinically suspected cases were young males attending the various departments of RMC with a history of long continued diarrhea, herpes zoster, extreme weight loss, miliary pulmonary tuberculosis, extrapulmonary tuberculosis, or pericardial effusion. Their histories suggested that many were IDUs, while a few only gave histories of unprotected sex with commercial sex workers. The report of a possible link between IDUs of Manipur and Madras suggests that HIV-2 may have come from Madras. The study of dual infection with both HIV-1 and HIV-2 among the IDUs may help in understanding the factors responsible for the efficient transmission of the two viruses. An extensive literature search found that HIV-2 among IDUs has previously been reported only from Spain approximately two years earlier.
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PMID:HIV-2 strikes injecting drug users (IDUs) in India. 852 32

Serosurveillance of high risk groups started in India in October 1985. The first positive cases were detected in 1986. As of mid-1994, official figures stood at 15000 HIV positive cases and 559 cases of AIDS. This is most certainly an underestimate because of under reporting. Among high risk groups, prevalence has risen rapidly. Between 1986 and 1994, prevalence has risen from 1.6 to 40.0% in sex workers, 1.4 to 40% in STD clinics and 0 to 70% in i.v. drug abusers in various studies. The penetration into the general population is uncertain. As in Africa, infection has been mainly by heterosexual intercourse, with commercial sex workers, long distance truck drivers and migrant labour serving as vehicles of spread. Other routes of infection are transfusion of blood and blood products and i.v. drug use. Dependence on professional blood donors is the main cause of infected blood supplies. Ninety per cent of cases with HIV infection are aged between 15 and 45 years and belong to socioeconomically disadvantaged groups. The male to female ratio is 5:1, with female cases being mainly sex workers. The predominant virus is HIV-1 but cases with HIV-2 and mixed infection are being reported from port cities. The present situation in India is similar to the early pattern in Africa where a sharp increase in seroprevalence among high risk groups was followed by spread to the general population. Clinical AIDS is still infrequent. From experience so far, pulmonary tuberculosis has been the most common clinical presentation. So far AIDS associated tuberculosis has responded to standard therapy but the development of multi-drug resistant mycobacteria and their spread to the large tuberculous population in the country is a potential threat. Key factors of AIDS/HIV prevention are public education and counselling about the infection and safe sex practices, especially in high risk groups; STD control; promotion of voluntary blood donation and adequate screening of blood products and general and equitable progress in the economic development of the country and its people-much high risk behaviour is driven by poverty.
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PMID:HIV and India: looking into the abyss. 867 31

In India, physicians examined and screened 100 AIDS patients aged 12-55 admitted to Government General Hospital in Madras for opportunistic infections as part of a study to document the characteristics of AIDS patients in Tamil Nadu State. 58% were 21-30 years old. The male/female ratio was 2:1. 94% had acquired HIV via heterosexual intercourse. 81% of all patients had multiple sex partners and unprotected penetrative sex. Around 66% had more than one opportunistic infection. The most common opportunistic infection was tuberculosis (61%), especially pulmonary tuberculosis (46%), followed by oral candidiasis (41%), cryptosporidial diarrhea (16%), and fungal infection of the skin (16%). The tuberculosis in most AIDS patients was reactivation of previously acquired tuberculosis. All tuberculosis patients responded well to standard treatment. The most common organism causing opportunistic infections was Staphylococcus pyogenes. Obstacles to acquiring more information about characteristics of these AIDS patients included the taboo of talking about sex and limited laboratory facilities. Clinicians should consider HIV in the differential diagnosis and management of all persons with tuberculosis.
Int J STD AIDS
PMID:Spectrum of opportunistic infections among AIDS patients in Tamil Nadu, India. 884 6

We examined all reports of adult AIDS cases made to the 2 national surveillance centres in the UK for changes in AIDS defining conditions between January 1982 and September 1994. Differences and changes among persons diagnosed since January 1988 who had and had not been aware of their HIV infection prior to their AIDS diagnosis were of particular interest. Pneumocystis carinii pneumonia (PCP) is the AIDS defining disease most often reported at the initial AIDS diagnosis. Its proportion of all AIDS cases has increased significantly between January 1982 and December 1987 and decreased markedly thereafter. Since January 1988 a significant decrease in the proportion of cases diagnosed with cryptosporidial infection was also observed while increases were observed in the proportion of cases diagnosed with: HIV wasting (chi(1)(2) = 5.56) PML (chi(1)(2) = 19.47), mycobacterium avium complex (chi(1)(2) = 35.76) and pulmonary tuberculosis (chi(1)(2) = 144.0). For cases diagnosed between January 1988 and September 1994, PCP was more likely to be diagnosed in patients previously unaware of their HIV infection (P < 0.01) as was extrapulmonary TB (P < 0.01). In contrast, the following diseases were more likely to be diagnosed in patients already aware of their HIV infection prior to the diagnosis of AIDS: oesophageal candidiasis (P < 0.001), HIV wasting (P = 0.07), mycobacterium avium complex (P = 0.0001), cytomegalovirus disease (P < 0.001), HIV encephalopathy (P = 0.0009) and cryptosporidial infection (P = 0.02). Prophylaxis and anti-retroviral therapy appear to have had a significant impact on the temporal changes of the most frequently diagnosed AIDS diseases. While PCP prophylaxis has substantially reduced the likelihood of a PCP diagnosis at AIDS, the corresponding increase in other opportunistic infections suggests that there may be a need for improved prophylaxis for these conditions.
Int J STD AIDS 1996 Jul
PMID:AIDS defining diseases in the UK: the impact of PCP prophylaxis and twelve years of change. 887 55

Findings are presented from a cross-sectional study conducted in 1995 in Bobo-Dioulasso, Burkina Faso, in which the patterns of diseases and CD4 counts among 266 HIV-infected adults of mean age 33 years were analyzed. The bioclinical spectrum of subjects' HIV disease is described and a simple alternative proposed to CD4 enumeration for screening and monitoring HIV-infected Africans. Dermatological symptoms and diarrhea were the most frequent signs associated with B-stage disease, while cachexia and digestive candidosis were the most frequent AIDS-defining diseases (ADD). Peripheral facial paralysis and cutaneo-mucous diseases were associated with weak immune deficiency. Pulmonary tuberculosis (TB) was close to B-stage diseases, and chronic diarrhea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). 90% of CDC C-stage subjects had CD4 counts of less than 350 per mcl, while only 75% had CD4 counts under 200/mcl. Regression analysis identified the lymphocyte count, clinical stage, and platelet count as predictors of CD4 count below 350/mcl. A lymphocyte count of less than or equal to 2500/mcl and clinical stage of B or higher is proposed to determine the CD4 threshold and to determine those patients in need of treatment to prevent wasting and opportunistic infections.
Int J STD AIDS 1998 Aug
PMID:A proposal for basic management of HIV disease in west Africa: use of clinical staging and haemogram data. 970 95

Manifestations of herpes zoster ophthalmicus (HZO) infection are well known in HIV-seropositive White patients in developed countries, but this association has not been previously noted in African AIDS patients. This paper analyzes 8 cases (3 men and 5 women) 24-40 years of age who were treated at the Eye Department of the University of Nigeria Teaching Hospital, Enugu, for HZO in 1994-97. Of the 6 patients who consented to HIV screening, 4 were HIV-seropositive. One of the HIV-infected patients had been treated for pulmonary tuberculosis a year prior to the present illness, but the remaining 7 were in apparent good health. The patients presented with skin eruptions in the area of distribution of the trigeminal nerve on the affected side of the face and head. Visual acuity was impaired in all 8 cases. The most common ocular findings were lid edema, ptosis, conjunctival infection, corneal anesthesia, keratitis, uveal inflammation, and abnormal pupillary reaction. The severity of presentation was similar in HIV-positive and HIV-negative patients and all improved during follow-up; however, clinical improvement was less rapid or pronounced among the HIV-positive patients. These findings suggest that HZO infection in young Africans should be regarded as a possible indicator of HIV infection.
Int J STD AIDS 1998 Aug
PMID:Herpes zoster ophthalmicus and HIV infection in Nigeria. 970 97

Information from routine and sentinel surveillance was used to monitor the HIV/AIDS epidemic in KwaZulu-Natal, South Africa between 1991 and 1997. Comparisons were made between data obtained from (1) sentinel surveillance for antenatal HIV infection, pulmonary tuberculosis (PTB), and AIDS in a single health district and (2) province-wide sentinel surveillance for antenatal HIV infection, legally required notification of cases of PTB, and voluntary notification of AIDS cases. HIV prevalence among antenatal clinic attenders in the sentinel district rose rapidly and at similar rates to provincial figures: 4.2% vs 4.8% in 1992 to 25.9% vs 26.9% in 1997. PTB incidence increased four-fold in the sentinel district over the study period, whereas provincial PTB figures from passive surveillance fluctuated widely and showed no clear increase (Chi-square for trend 425.5, P<0.00001). AIDS incidence in the sentinel district increased dramatically while provincial data from the voluntary reporting system showed a less consistent and much slower rise (Chi-square for trend 9.07, P=0.003). Incidence of AIDS in 1997 was estimated as 437/10(5) in the sentinel district compared to 32/10(5) in the provincial figures. Routine disease notification and voluntary reporting systems are likely to underestimate the impact of the HIV/AIDS epidemic in resource-poor settings. Sentinel surveillance at representative sites should be developed to validate or replace passive surveillance systems.
Int J STD AIDS 1999 May
PMID:Routine reporting or sentinel surveys for HIV/AIDS surveillance in resource-poor settings: experience in South Africa, 1991-97. 1036 23


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