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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Modes of preventing the spread of AIDS that have been successful are reviewed. Marked reduction in rates of seroconversion have been recorded among homosexuals in San Francisco and Stockholm, despite high seroprevalence of HIV, due to cohesiveness of the community and intense, direct educational campaigns. Although condoms used with nonoxynol-9 spermicide reduce markedly the likelihood of HIV transmission, heterosexual spread of HIV has not been curtailed. Particularly difficult to reach groups are bisexual men, prostitutes using oral contraceptives, heterosexuals already infected with sexually transmitted diseases, especially chancroid, herpes and syphilis, and young people. In Sweden, needle exchange programs have contained AIDS spread abruptly. Paradoxical effects of fear of AIDS in the drug community have worsened the situation in the U.S. For example, fear that heroin causes AIDS has increased the use of cocaine, with its more demanding addiction, that ultimately spreads HIV more rapidly by sexual routes. Spread of HIV by blood products and to health care workers has become a very rare event recently in the U.S. There is hope that the health message is being articulated more effectively, easing fear and enhancing the response by individuals at risk.
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PMID:AIDS prevention: issues and strategies. 314 75

The cellular immune responses to fractionated Haemophilus ducreyi antigens, coated on latex beads, were assessed in patients with chancroid and in controls, using an in vitro lymphocyte proliferation assay. Several fractions of H. ducreyi antigen revealed stimulating activity. However, only the molecular size ranges 91-78 kD, 59-29 kD, and 25-21 kD induced proliferation that may be specifically related to H. ducreyi infection. Lymphocytes from four HIV- patients, successfully treated for chancroid, were not stimulated by H. ducreyi antigen. In general, lymphocytes from HIV+ chancroid patients were less responsive to H. ducreyi antigen compared with those from HIV- chancroid patients. However, two HIV-infected patients showed exceptionally strong responses to high molecular weight fractions. To our knowledge this is the first report demonstrating that H. ducreyi contains specific T cell-stimulating antigens. Based on this work, further identification and purification of the T cell antigens is feasible.
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PMID:In vitro stimulation of peripheral blood mononuclear cells (PBMC) from HIV- and HIV+ chancroid patients by Haemophilus ducreyi antigens. 758 73

During May 1994-July 1995 in India, health workers at two clinics for sexually transmitted diseases (STDs) in Pune provided HIV serological screening and a physical examination to 2800 patients who completed a questionnaire, so that researchers could identify risk factors for HIV-1 infection in this high-risk population. 60% of the female STD patients were sex workers. 90% of the men had contact with a sex worker within the last 3 months. 14% of all STD patients were women who were not sex workers. 82% of these were married and monogamous. 13% of the married and monogamous women tested positive for HIV-1. Overall, 23.4% of all STD patients tested positive for HIV-1. Only 24% of all STD patients had used condoms during the last 3 months. The leading clinical diagnosis was chancroid (33% for men and 20% for women). The logistic regression analysis showed that the risk factors for HIV-1 infection were: being a sex worker (odds ratio [OR] = 3.7; p 0.001), contact with a sex worker (OR = 1.71; p = 0.01), receptive anal sex (OR = 3.52; p 0.001), tattooed after 1985 (OR = 1.31; p = 0.01), current or previous genital ulcer (OR = 1.29; p = 0.01), and a positive result of a Venereal Disease Research Laboratory test (OR = 1.33; p = 0.01). Protective factors were some formal education (OR = 0.76; p = 0.02), and condom use (sometimes/always, OR = 0.75; p = 0.03). These findings indicate a need for comprehensive and national STD services in India to control STDs and a health education campaign on HIV/AIDS to reduce high risk behavior.
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PMID:Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India. 763 30

Of the approximately 15 million HIV infections that have occurred since the epidemic began, over 10 million have been transmitted heterosexually. Although there have been studies to show that HIV-1 is relatively inefficiently transmitted heterosexually and substantially less readily transmitted than is herpes simplex 2 virus or human papilloma virus, studies in Kenya have identified 5 factors that facilitate heterosexual spread of HIV-1: 1) promiscuity, 2) other sexually transmitted diseases (ulcers, particularly chancroid), 3) cervical ectopia, 4) uncircumcised men, and 5) increased titers of HIV-1 secreted in the genital secretions of immunosuppressed patients. Poverty, illiteracy, discrimination and stigmatization, gender inequality, low respect for human rights, and political and civil unrest are also underlying determinants of HIV epidemiology. The World Health Organization Global Program on AIDS has mobilized resources to control AIDS, but culturally inappropriate interventions can be detrimental to slowing and stopping the spread of HIV-1. HIV prevention is difficult because of the stigmatization associated with it, the long incubation period negates awareness of cause and effect, and sexual behavior is poorly understood in all societies. Specific interventions comprise: 1) a defined mission with strong links to the national head of state and annual review of the program goals and strategies; 2) mass media and targeted educational campaigns to increase public awareness of AIDS and encourage behavior change; and 3) the synergism between HIV and other sexually transmitted diseases provides an opportunity for targeted interventions. Among specific interventions are: 1) Behavioral interventions for vulnerable groups. In Thailand condom promotion, prostitute and brothel registration, and education of those in male risk groups resulted in a 70% reduction in cases of STDs. 2) Improved clinical services for sexually transmitted infections. 3) Research to understand sexual health. 4) Integration of HIV- and STD-control programs. Physical and chemical barriers should be the major strategy of reduction and prevention of HIV transmission.
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PMID:Slowing heterosexual HIV transmission. 767 67

The heterosexual transmission of HIV-1 is highly efficient in sub-Saharan Africa. Being uncircumcised and having genital ulcer disease (GUD) are two factors which put men at risk for acquiring infection with HIV-1. In turn, uncircumcised men with GUD are an important high frequency HIV-1 transmitter core group. While the pathogenesis of GUD remains unclear, it probably requires an initial minor abrasion of normal skin, common among uncircumcised men with poor genital hygiene and areas of mucosal discontinuity on the penis. The moist environment under the foreskin hinders the rapid healing of subpreputial abrasions and also provides a fine receptacle for the retention of sexually transmitted pathogens. Damage to the superficial subpreputial mucosa, which may be exacerbated if traumatized during sexual intercourse, forms a highly plausible entry point for HIV-1. Chancroid, the most common cause of GUD in Africa, was successfully controlled with a range of prophylactics during the first and second world wars, including basic hygiene using soap and water. Washing of the penis with soap and water should again be considered as a means of preventing both GUD and HIV-1 in uncircumcised men. By facilitating the healing of traumatic, inflammatory, and infected penile lesions, pre- and post-exposure prophylaxis with soap and water could be a cheap and effective method for decreasing the risk of acquiring GUD and HIV in such men.
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PMID:Soap and water prophylaxis for limiting genital ulcer disease and HIV-1 infection in men in sub-Saharan Africa. 772 Dec 93

The World Health Organization (WHO) criteria for HIV clinical disease were tested among individuals with high-risk behavior in northern India. A questionnaire, based upon history and physical examination alone, standardized by the WHO to include both major and minor signs necessary for the clinical diagnosis of AIDS in adults was applied to 165 consecutive patients attending the STD clinic of Dr. R.M.L. Hospital, New Delhi. All patients were screened for the presence of STDs by the dermatologist in charge of the clinic, with patients fulfilling two major and at least two minor WHO criteria eventually classified as having clinical AIDS based upon the WHO case definition. Each of those patients was subjected to serological confirmation of the clinical suspicion using ELISA and Western blot commercial tests. Of the 165 patients screened, a definite diagnosis of STD was possible in 85. These patients were 20-45 years old (mean age, 30.59 years). All were male and chancroid was the most common STD in the cohort. Of the 85, only one satisfied the WHO clinical criteria for AIDS. Serological investigations, ELISA, and Western blot confirmed the subject's HIV-seropositive status. These results indicate that in northern India, clinical HIV disease remains rare even among individuals with high-risk behavior. The low prevalence of clinical HIV disease in that part of the country makes it difficult to assess the specificity and sensitivity of the WHO clinical criteria for AIDS.
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PMID:Surveillance of STD patients for AIDS using World Health Organisation criteria. 775 6

A comparative open study was performed to evaluate the efficacy of single doses of ciprofloxacin (500 mg) and trimethoprim-sulfamethoxazole (TMP-SMZ; 640 mg/3,200 mg) for the treatment of culture-proven chancroid. Clinical cure or improvement was observed 7 days after treatment in 32 (76.2%) of the 42 patients who received ciprofloxacin and 21 (52.5%) of the 40 patients who received TMP-SMZ (P = .04). Cultures for one (4.5%) of 22 patients not cured with ciprofloxacin and 16 (59.3%) of 27 patients not cured with TMP-SMZ were still positive for Haemophilus ducreyi 7 days after treatment (P < .001). Although 77 (71.3%) of the 108 patients tested were seropositive for HIV-1 antibody, HIV infection and the degree of CD4+ lymphocyte depletion had no effect on clinical and bacteriologic outcome. All isolates of H. ducreyi were highly susceptible to ciprofloxacin (MIC, 0.004-0.06 mg/L). In contrast, resistance to TMP-SMZ (MIC, > or = 4/76 micrograms/mL) was observed in 48.9% of isolates (22 of 45) and was significantly associated with treatment failure. Therefore, the administration of TMP-SMZ, in single or multiple doses, is no longer indicated for the treatment of chancroid in Rwanda.
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PMID:Failure of treatment for chancroid in Rwanda is not related to human immunodeficiency virus infection: in vitro resistance of Haemophilus ducreyi to trimethoprim-sulfamethoxazole. 779 96

Genital ulcerated disease (GUD), which includes chancroid, has been identified as a risk factor for HIV transmission. This study reports the prevalence of anti-Hemophilus ducreyi (chancroid) antibodies in 1831 Ethiopian women and looks at the behavioral and social factors which might affect the incidence and potential spread of chancroid. Patient data regarding ethnic and socioeconomic aspects were collected from detailed questionnaires. Blood collection was performed under medical surveillance. Complete gynecological examinations were performed. Papanicolaou stained smears were used as the basis of the cytological data. Serological studies utilized an enzyme immunoassay (EIA) test for STD detection. Statistical tests used included the Chi-square test, the multivariate analysis technique, and the Cochran-Mantel-Haenszel General Association Statistic Test. Antibodies to H. ducreyi were found in 335 women (19.4%). Prevalence of H. ducreyi was significantly associated with Amhara or Tigre ethnic heritage; older age; first coitus before beginning menstruation; history of STDs; divorced status; being a prostitute; longer duration of married and sexual life; and younger age at first coitus. Logistic regression demonstrated that 3 factors were significant when associated with H. ducreyi seropositivity. First coitus before beginning menstruation was highly significant (OR 1.95; 95% CI, 1.49-2.57; P 0.0001). Not being still married to the first husband was also significant (OR 1.68; 95% CI, 1.23-2.30; P 0.001). Being of the Ethiopian Orthodox religion was significant (OR 2.11; 95% CI, 1.21-3.68; P 0.005). Prevalence in women with 2-5 lifetime husbands was higher than in women with only 1 husband.
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PMID:Seroepidemiological studies of Haemophilus ducreyi infection in Ethiopian women. 781 62

Men with genital ulcer disease (GUD) attending a clinic in Malawi were evaluated and treated with one of five drug regimens. Haemophilus ducreyi was isolated from 204 (26.2%) of 778 patients. Of 677 men, 198 (29.2%) had treponemes detected in ulcer material by direct immunofluorescence or had rapid plasma reagin reactivity of > or = 1:8. Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 58.9% overall and 75.8% among patients reporting a history of GUD (P < .001). By logistic regression analysis, HIV-1 seropositivity was shown to impair ulcer healing (P = .003). Treatment failure rates for culture-proven chancroid were 19% for trimethoprim-sulfamethoxazole, 12.9% and 7.4%, respectively, for low- and high-dose erythromycin regimens, and 8.3% and 0, respectively, for low- and high-dose ciprofloxacin regimens. Herpes antigen was detected by EIA in 6 (23.1%) of 26 nonhealing ulcers. In Malawi, GUD should be managed as a syndrome to assure treatment of both syphilis and chancroid.
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PMID:Sexually transmitted diseases and human immunodeficiency virus control in Malawi: a field study of genital ulcer disease. 784 88

This article will review the 1993 STD Treatment Guidelines of particular importance to dermatologic clinical practice. Topics include STD/HIV prevention, management of sexual partners, STD in persons with HIV co-infection, genital ulcer disease (GUD) including syphilis, herpes simplex virus (HSV) infection, lymphogranuloma venereum (LGV) and chancroid, therapy of nongonococcal (NGU) and chlamydial urethritis and cervicitis, gonococcal (GC) infections, HPV infection, hepatitis B virus (HBV) infection, pediculosis pubis, and scabies.
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PMID:The 1993 sexually transmitted disease treatment guidelines. 784 21


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