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

A retrospective study of 55 HIV-1 seropositive African patients living in the UK, seen between January 1986 and November 1993, showed a total of 26 (47%) patients with AIDS. Thirty-one (56%) had symptomatic HIV disease at the time of presentation of whom 19 (34.5%) had an AIDS defining condition. Tuberculosis was the most common AIDS defining illness, accounting for 27% of all initial AIDS diagnoses, followed by by Pneumocystis carinii pneumonia and oesophageal candidiasis in 19% each and chronic mucocutaneous genital herpes in 15%. The mean CD4 count at the time of the first AIDS defining event was 91 x 10/mm3 (range 4-320 x 10/mm3). The profile of AIDS defining illnesses was different to published data of homosexual men and injecting drug users in the UK. This has practical implications when considering differential diagnoses and screening as well as prophylaxis for opportunistic infections in this group of patients.
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PMID:AIDS defining conditions in Africans resident in the United Kingdom. 865 11

We describe a 28-year-old HIV-infected woman with AIDS, defined by cerebral toxoplasmosis and a CD4-count of less than 10 x 10(6) cells/I, who, after several eruptions of genital herpes and typical dermatomal herpes zoster, all successfully treated with acyclovir, developed chronic cutaneous ulcerating lesions on a finger and on the tibia. The lesions were found to contain varicella zoster virus antigen but repeated treatment courses with acyclovir were unsuccessful. After a course of intravenous foscarnet the lesions resolved. They recurred after discontinuation of foscarnet but finally responded to a second course of treatment.
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PMID:Chronic ulcerating acyclovir-resistant varicella zoster lesions in an AIDS patient. 868 44

It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently hence necessitating screening in individuals attending Genito-Urinary Medicine (GUM) clinics. However there are few data on individuals with more than one concurrent STD. Individuals attending the GUM Department in the Royal Infirmary of Edinburgh between 1990 and 1994 with the diagnosis of HIV infection, genital warts, genital herpes, non-specific genital infection (NSGI), gonorrhoea and syphilis were included in the study. A multivariate comparison was made between those presenting with multiple concurrent STDs and a control group comprising individuals with a solitary STD with respect to year of attendance, social class, location of acquisition of infection, sex, sexual orientation and age using a logistic regression model. A total of 680 of 9265 patients in the study period had more than one concurrent STD. Individuals in lower socio-economic class were at higher risk and older individuals at lower risk of multiple concurrent STDs. Multiple sexually acquired infections are common in individuals who attend GUM clinics. Age and socio-economic class were the only significant variables. Identification of populations at highest risk for multiple infection can direct interventions against all STDs.
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PMID:Characterizing patients with multiple sexually acquired infections: a multivariate analysis. 889 26

A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care center in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, the authors simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simply syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection. (author's)
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PMID:Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda. 890 69

The incidence of genital herpes is increasing worldwide and herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among sexually transmitted diseases (STDs). Findings are reported from an assessment of the prevalence of antibodies to HSV-2 in low- and high-risk populations in Brazil. 155 voluntary blood donors and 85 HIV-seropositive homosexual and promiscuous heterosexual men were screened with ELISA for infection with HSV-2 during February-August 1994. 20 highly active prostitutes were also studied during May-July 1994. The subjects were of mean age 30 years, 70% were sexually active at the time of the study, and 6.55% used condoms. Antibodies to HSV-2 were detected in 29.1% of the blood donors, 73% of the HIV-seropositive men, and 72% of the overall high-risk group. Only 10%, however, admitted to ever having episodes of genital herpes. HSV-2 infection was significantly and independently associated with years of sexual activity, history of previous STDs, number of sex partners in the previous month, number of pregnancies, number of induced abortions, and the percentage of sex acts involving receptive anal intercourse. Routine screening for HSV-2 infection should be considered in populations at high risk for STDs.
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PMID:Herpes simplex virus type 2 in Brazil: seroepidemiologic survey. 891 32

The presence of human papillomavirus (HPV) DNA in esophageal brushings from human immunodeficiency virus (HIV)-seropositive hosts was investigated in a cross-sectional study. Oral and esophageal brushings from individuals scheduled for esophagogastroscopy (53 HIV-positive and 61 age-matched HIV-negative patients) were tested for the presence of HPV DNA by a consensus L1 polymerase chain reaction assay. HPV DNA was detected in esophageal brushings of 9 (17%) of the 53 HIV-seropositive patients and 0 of the 61 HIV-negative individuals. HPV-16 DNA was the most frequently detected. No proliferative mucosal lesion was noted in individuals with HPV-positive esophageal brushings. Cytological smears were done for 6 of the 9 patients with HPV-positive esophageal brushings, and epithelial atypia was recorded for 1. HIV infection and a history of genital herpes were strong independent predictors of HPV, suggesting that HPV is transmitted sexually in the esophagus.
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PMID:Human immunodeficiency virus infection is a major risk factor for detection of human papillomavirus DNA in esophageal brushings. 914 28

Viral sexually transmitted diseases (STDs) are a major health problem for women. Over many years the incidence of these infections has increased steadily to epidemic proportions. These infections not only cause short-term morbidity but also have been associated with significant long-term morbidity and mortality. This paper focuses on two of the most common viral STDs-Genital Herpes Simplex Virus (HSV) infection and Human Immunodeficiency Virus (HIV) infection of the female. The steady increase in the incidence of HIV infection and subsequent adult immunodeficiency disease (AIDS) among women requires health care providers to assume an active role in detection and treatment in order to avoid transmission, to protect the health of women with HIV/AIDS, and to reduce the risk of maternal-fetal (vertical) transmission. Because treatment with zidovudine has been shown to reduce vertical transmission, routine offering of HIV testing is currently recommended for all pregnant women. The approach to testing nonpregnant patients, i.e., the choice between selective screening or routine testing, rests with the individual clinician. Testing large numbers of patients within a practice may be facilitated by the availability of an oral antibody testing system. The sensitivity and specificity of the oral test is equivalent to blood testing. Serum and oral specimens are tested by enzyme-linked immunosorbent assays (ELISA) and confirmatory Western blot assays specifically designed for use with oral samples. Controversies in diagnosis as well as the most updated treatments for these infections are discussed.
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PMID:Diagnosis and treatment of viral STDs in women. 916 Feb 21

In many western countries, successful control of bacterial sexually transmitted diseases (STDs) has contrasted with an increase in the prevalence of viral STDs. The continued increase in clinical and subclinical genital herpes infections is of particular concern because of the implications for the risk of coincident spread of human immunodeficiency virus infection. Advances in knowledge of the epidemiology and natural history of genital herpes must be the basis of renewed educational efforts targeted at the general public, healthcare professionals, as well as infected persons. Diagnostic techniques, such as polymerase chain reaction and type-specific serology, now allow increased detection of subclinical infection. However, infected persons must be assured of access to effective antiviral treatment and comprehensive holistic management if the clinical and epidemiological benefits of detection are to outweigh the psychological and psychosocial disadvantages of being infected with a stigmatized condition. Vaccines could offer the best prospect for both primary prophylaxis and immunotherapy of genital herpes, and may have the greatest impact in limiting the spread of this infection. Recent progress has been made in the development of effective and safe vaccines, and their successful introduction should be a major priority over the next decade.
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PMID:Limiting the spread of genital herpes. 916 19

Vaginal sponges offer women control over protection against both pregnancy and sexually transmitted diseases (STDs), including HIV. Spermicide-impregnated sponges combine the actions of a physical barrier that blocks the cervix with a material that absorbs the ejaculate and a spermicide. Commercially available spermicides contain 1-5% of nonoxynol-9, shown to inhibit organisms responsible for gonorrhea, chlamydia, candidiasis, genital herpes, syphilis, trichomoniasis, and HIV. On the other hand, nonoxynol-9 is associated with a significantly higher risk of vaginal colonization with bacterial agents, ulcerative genital diseases, and vulvitis. A lower dose of nonoxynol-9 appears to avert vaginal irritation without compromising contraceptive efficacy. Use of chlorhexidene, a spermicide less irritating to mucosal cells than nonoxynol-9 but active against HIV in vivo and in vitro, is under investigation. Also promising are initial findings regarding the Protectaid contraceptive sponge with F-5 gel. Epidemiologic studies and clinical trials should provide quantitative estimates of the level of protection offered by barrier methods and identify the method that combines the highest protection, ease of use, and user acceptability.
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PMID:Anti-STD vaginal contraceptive sponges. 923 1

The specific mechanisms underlying the varied susceptibility of HIV-infected (HIV+) individuals to opportunistic infections (OI) are still incompletely understood. One hypothesis is that quantitative differences in specific T cell responses to a colonizing organism determine the development of an AIDS-defining OI. We evaluated this hypothesis for herpes simplex virus (HSV) infection, a common OI in HIV+ patients. Using limiting dilution analyses, the frequency of HSV-specific CD8+ cytotoxic T lymphocyte precursors (pCTL) and proliferative precursors were quantitated in peripheral blood mononuclear cells from 20 patients coinfected with HIV and HSV-2. The frequency of HSV-specific CD8+ pCTL in HSV+HIV+ individuals was significantly lower than in HSV+HIV- individuals (1 in 77,000 vs. 1 in 6,000, P = .0005) and was not different than in HSV-HIV- individuals (1 in 100,000, P = .24). HIV+ patients who suffered more severe genital herpes recurrences had significantly lower HSV-specific CD8+ pCTL frequencies than those patients with mild recurrences (1 in 170,000 vs. 1 in 26,000, P = .03). In contrast, no significant difference was seen in proliferative precursor frequencies between those patients with mild vs. severe genital herpes (1 in 3,800 vs. 1 in 6,600, P > .5). Quantitative differences in pCTL frequency to HSV appear to be the most important host factor influencing the frequency and severity of HSV reactivation in HIV+ patients. Studies to reconstitute such immunity, especially in people with acyclovir-resistant HSV, appear warranted.
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PMID:Severe genital herpes infections in HIV-infected individuals with impaired herpes simplex virus-specific CD8+ cytotoxic T lymphocyte responses. 929 3


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