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

To evaluate the impact of human immunodeficiency virus (HIV) on human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN), a study was conducted of 147 HIV-seropositive and 51 HIV-seronegative prostitutes in Nairobi, Kenya. Among the women infected with HIV, 10 (7%) had signs or symptoms of significant HIV-related disease, and the remaining 93% were asymptomatic. The prevalence of cervical HPV DNA was 37% among HIV-seropositive women and 24% in HIV-seronegative women (odds ratio [OR] 1.7, 95% confidence intervals [CI] 0.8, 3.6, after adjusting for potential confounding factors). Genital warts, cervical HPV DNA, and cytologic findings consistent with CIN were all significantly associated with younger age and fewer years of prostitution, but were unrelated or weakly related to number of sexual partners per week or frequency of condom use. In a subset of 63 women with evaluable Papanicolaou smears, CIN was found in 50% of the women with HPV but only in 8% of those without HPV (adjusted OR 7.2, 95% CI 1.6, 32.1, P = 0.006). However, CIN was unrelated to HIV seropositivity (prevalence of 26% among HIV-seropositive women and 24% in HIV-seronegative women). Among women with cervical HPV DNA, HIV infection was not associated with an increased prevalence of CIN (47% prevalence among women with HIV versus 57% prevalence among women without HIV). Thus, in this population of HIV-seropositive women, most of whom had CDC Stage II or III infection, there was no demonstration of an adverse impact of HIV on CIN.
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PMID:Human immunodeficiency virus, human papillomavirus, and cervical intraepithelial neoplasia in Nairobi prostitutes. 131 92

Evidence from many countries suggests an association of human immunodeficiency virus (HIV) infection and tuberculosis of major public health significance. In order to begin assessing the impact of HIV on tuberculosis in Kenya, we have determined the HIV-1 seroprevalence among tuberculosis patients and compared the clinical characteristics of tuberculosis in HIV-positive and HIV-negative patients in two cross-sectional studies at the Infectious Disease Hospital (IDH) and the Ngaira Avenue Chest Clinic (NACC), Nairobi, Kenya. The diagnosis in 92% of all patients with pulmonary tuberculosis was confirmed by culture. The remainder were diagnosed on histological, clinical or radiological grounds. HIV seroprevalence among tuberculosis patients at IDH was 26.5% (52/196) compared to 9.2% (18/195) at NACC (P less than 0.001). There was no association between numbers of streptomycin injections in the previous 5 years and HIV infection. Positive sputum smear rates in HIV-positive patients were slightly lower than in HIV-negative patients at both study sites (71% vs 83% at IDH and 73% vs 82% at NACC) but the difference was not significant. Only Mycobacterium tuberculosis was isolated. Miliary disease was not associated with HIV infection. Persistent diarrhoea, oral candidiasis, generalized itchy rash, herpes zoster and generalized lymphadenopathy were all associated with HIV infection, but 46% (95% CI:38-54%) of all HIV-positive patients had none of the clinical features listed in the WHO Clinical Criteria for the Diagnosis of AIDS, apart from fever, cough and weight loss. Stevens-Johnson Syndrome was reported in 7/52 (13%) patients with HIV infection, and in 4/144 (3%) patients without (RR 4.85, 95% CI: 1.45-15.88).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cross-sectional survey of HIV infection among patients with tuberculosis in Nairobi, Kenya. 138 70

Retrospective studies suggest that the mortality rate from HIV-1-associated tuberculosis is greater than that from tuberculosis alone, but it is not clear if this is due to failure of antituberculosis treatment or to the complications of HIV-1 infection. We have carried out a prospective cohort study of patients with tuberculosis in Nairobi, Kenya, to compare mortality rates, risk factors, and causes of death in HIV-1 positive and HIV-1 negative patients. One hundred seven HIV-1 positive and 174 HIV-1 negative patients with tuberculosis attending two tuberculosis treatment centers in Nairobi were enrolled and followed monthly. Mortality was significantly higher in HIV-1 positive than in HIV-1 negative patients within 6 months of the start of antituberculosis treatment after adjustment for age, sex, and education (rate ratio = 3.8; 95% confidence interval, 1.7 to 8.1; p less than 0.001). Most of the excess mortality occurred after the first month of treatment and was due to nontuberculous infections. Predictors for mortality differed greatly between HIV-1 positive and HIV-1 negative patients. Mortality was greater in HIV-1 positive patients treated with a "standard" regimen for tuberculosis than in HIV-1 positive patients receiving a "short-course" regimen (p = 0.08 when adjusted for all independent risk factors). Tuberculosis control programs in developing countries need to implement "short-course" regimens and train health workers to recognize and treat nontuberculous infections to maintain their effectiveness in the face of the HIV epidemic.
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PMID:Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality. 141 9

The range of clinical presentations of HIV-related disease in Africa has not been adequately described, despite the fact that many hospitals have to rely heavily on clinical diagnosis. Six hundred adult medical patients seen in the Casualty Department of the main Government hospital in Nairobi were enrolled in a study of the presentation and outcome of HIV-related disease: 506 of these patients were admitted, of whom 19 per cent (95) were HIV seropositive. The remaining 94 were dealt with as outpatients: 11 percent (10) of these were seropositive. A history of prior treatment for sexually transmitted disease and, if male, being uncircumcised, were associated with being seropositive. Three presentations were strongly associated with HIV infection: acute fever with no focus except the gastrointestinal tract (enteric fever-like illness), acute cough with fever (community-acquired pneumonia) and chronic diarrhoea with wasting. The WHO clinical case definition (CCD) for AIDS missed a substantial amount of HIV-related morbidity (sensitivity 39 per cent) and misidentified many seronegative patients (positive predictive value 59 per cent). In comparison with the Centers for Disease Control surveillance definition for AIDS, the CCD was specific (91 per cent) and sensitive (79 per cent) but only had a positive predictive values of 30 per cent: the CCD may therefore be a poor surveillance tool for AIDS. Seropositive patients were much more likely to die than were seronegative patients (39 per cent vs. 15 per cent mortality). Enteric fever-like illness was the presentation which most commonly proved fatal. A wider spectrum of disease is associated with underlying HIV immunosuppression than has previously been described in Africa.
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PMID:The presentation and outcome of HIV-related disease in Nairobi. 143 66

Between January 1989 and December 1991, health workers took blood samples from 4883 pregnant women attending the Nairobi City Commission's Langata Clinic in Nairobi, Kenya to determine demographic factors and indicators of sexual behavior to explain the increase in HIV-1 infection and syphilis among these women of low socioeconomic status. HIV-1 seroprevalence stood at 8.8%. Syphilis seroreactivity was 3.6%. HIV-1 seropositive mothers were 2.5 times more likely to also test positive for syphilis than were HIV-1 seronegative mothers (7.7% vs. 3.2%; p.001). There was no significant association between HIV-1 seropositivity and gonococcal infection rate (7.3% vs. 8.9%), however. Women who tested HIV-1 positive tended to be from western Kenya (60.1% vs. 39.1%; p.0001). Between 1989 and 1991, annual HIV-1 seroprevalence rates increased from 6.5% to 13% (p.001) as did annual syphilis seroreactivity rates (2.9-5.3%; p=.02). The HIV-1 seroprevalence rates remained high, but did not rise significantly among syphilis seroreactive women between 1989 and 1991 (17.9-20.7%). They did rise among syphilis seronegative women (6.9-12.5%; p.0001), however. The HIV-1 infection rate increase was greater among 25-year old women (5.6-13.2%; p.001) than it was among 25-year old women (6.8-12.7%; p=.09). Indeed the annual incidence rate for 25-year old women was 3-4%. Between 1989-1991, there was a decrease in the percentage of both HIV-1 seropositive and seronegative women who had had 1 sex partner during the last 2 years (39.1% vs. 20%; p=.0001). Demographic factors remained the same throughout the study period. These results verified the link between HIV-1 infection and syphilis and their rapid rise among women in low risk groups. Thus there was a pressing need to improve HIV-1 and sexually transmitted disease prevention programs.
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PMID:Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya. 146 50

Chancroid is linked to the spread of human immunodeficiency virus type 1 (HIV-1) in East Africa. Effective, easily administered therapy is a priority for the control of Haemophilus ducreyi. The efficacy of a single oral dose of fleroxacin, 400 mg, was compared to a 3-day oral course of trimethoprim-sulfamethoxazole (TMP-SMZ), 160/800 mg, twice daily for the treatment of chancroid in 98 HIV-1-seronegative men in Nairobi, Kenya. No differences were noted between the two groups with respect to demographic characteristics, sexual behavior, and clinical characteristics. Culture-proven failure occurred in 1 (3%) of 36 fleroxacin-treated patients and in 11 (30%) of 37 TMP-SMZ-treated patients (P = .005). Fleroxacin, as a single oral dose, is an effective treatment for culture-proven chancroid in patients who are HIV-1 seronegative. TMP-SMZ is no longer predictably effective due to the recent emergence of resistance to both sulfonamides and to trimethoprim.
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PMID:A randomized, double-blind study of the efficacy of fleroxacin versus trimethoprim-sulfamethoxazole in men with culture-proven chancroid. 156 47

In 1980, the US Food and Drug Administration found nonoxynol 9 to be safe and effective as a vaginal contraceptive and, with regard to local toxicity, its decision on results of only 1 animal study and the shortage of reported significant adverse effects in humans, and not on clinical trials. Even though little research has looked specifically at vaginal spermicide toxicity to genital and rectal epithelia, other research reported genital irritation rates ranging from minimal to 10%. Nevertheless most literature reviews on nonoxynol 9 concluded that any reports of local toxicity were only minimally significant. Many studies have indicated that nonoxynol 9 protects against sexually transmitted diseases, but most of these did not control for consistency and frequency of use, different sexual practices, and the use of barrier methods. In fact, 1 study revealed a positive association between nonoxynol 9 and candida infections. In vitro research has consistently demonstrated nonoxynol 9's ability to inactivate HIV, but little research in humans exists on its safety and effectiveness in preventing HIV infection. The earliest report of local toxicity involved research in Nairobi, Kenya. It revealed who used vaginal sponges with nonoxynol 9 than those who used vaginal suppositories without it. These genital ulcerations may have indeed facilitated HIV entry thereby contributing to the higher incidence of new HIV infections among those using nonoxynol 9. Another study revealed that among 71 sex workers using condoms lubricated with nonoxynol 9 in Vancouver, British Columbia 53.5% reported adverse reactions. In the recent past, published information about AIDS in the US and UK promoted use of condoms lubricated with nonoxynol 9, but did not tell users about the possible adverse effects. Since research has not verified the safety of nonoxynol 9 with regard to local toxicity, its potential benefits in HIV prevention cannot yet be determined.
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PMID:The use of spermicide containing nonoxynol-9 in the prevention of HIV infection. 132 95

In 1989 the Global Program on AIDS (GPA) of the World Health Organization estimated that there were 2.5 million women and half a million children infected with HIV-1 in Africa. A study carried out in two maternities in Kinshasa, Zaire, in 1988 showed higher mortality rates in previously born children of seropositive mothers compared with children of seronegative mothers (43% vs. 32%, p 0.01). A case control study in Nairobi of patients admitted with an acute spontaneous abortion indicated that HIV-1 infection was significantly associated with spontaneous abortion (13.8% vs. 6.2%. p = 0.02). In another study from Nairobi the mean birth weight of infants born to seropositive mothers was slightly but significantly lower than the birth weight of infants with seronegative mothers (3090 vs. 3220 g, p = 0.005). In the Kinshasa study more infants born to HIV-1 seropositive mothers with symptomatic infection were delivered before 38 weeks of gestation compared with neonates of HIV-positive asymptomatic or seronegative women (18%, 12%, and 3%, respectively, p 0.01). In the Nairobi study abnormalities were noted in 115 stillborn neonates, and maternal HIV-1 infection (odds ratio of 2.7) was a contributory factor. Among the 68 live-born infants with HIV-1 seropositive mothers in the Kinshasa study, there were 29 (6.2%) neonatal deaths compared with 8 (1.3%) among infants of seronegative women (p 0.0001). In addition, chorioamnionitis was found significantly more often in the placentas of infants of HIV-1 seropositive mothers with AIDS than among placentas of infants born to asymptomatic seropositive women or seronegative controls (21.4% vs. 1.0% and 2.9%, respectively, p 0.01). In another Nairobi study in 1990 a single session of counseling of HIV-1 seropositive women did not seem to influence their subsequent condom use or reproductive behavior. Pregnancy seemed to accelerate the progression of the disease because of its immunosuppressive effect. The diagnosis of perinatal HIV infection has been difficult and the use of the polymerase chain reaction method has been the most sensitive test.
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PMID:The effect of HIV-1 infection during pregnancy and the perinatal period on maternal and child health in Africa. 166 28

The article proposes that the clinical case definition for Acquired Immunodeficiency Syndrome in Africa is an unworkable concept, with the wrong definition, incorrect validation, improper use, and consequently is a poor surveillance tool. The definition was proposed by the World Health Organization in 1986 to satisfy the use in countries with limited diagnostic resources, and resources for serological testing. Critical review until now of this procedure was lacking. Currently serological testing is available and of high quality. It does not seem justifiable to continue using a provisional surveillance definition. Abandoning this classification procedure may also lead to the focus on problems other than opportunistic infections and AIDs. Clinical surveillance is important, but as well morbidity and mortality need monitoring. It is argued that the definition is an unworkable concept because patients with underlying immunosuppression disorders such as AIDs can not be easily distinguished from chronic disease patients; i.e., pulmonary tuberculosis, renal failure, uncontrolled diabetes, or diarrhea with weight loss. Clinical accuracy is insufficient. It is the wrong definition because pulmonary tuberculosis with a persistent cough cannot be distinguished for those HIV positive and those not. There is inconsistency in the WHO clinical definition and the Centers for Disease Control definitions of AIDs. The incidence of tuberculosis in countries with unmodified clinical case definitions may contribute to an inflated number of AIDs cases. The wrong standards were used to validate the WHO definition in evaluative studies. The reference sensitivity ranges indicate that the definition is insensitive to identifying seropositive patients. Also, the HIV status of patients does not equate with AIDs. Although designed for surveillance, the clinical case definition is used by doctors for individual patient management. Labeling a patient as having AIDs, when he is HIV negative, leads to negative consequences. Researchers compare African AIDs data with North American data with imprecise and noncomparable definitions. As a surveillance tool in countries with a fragmentary or without a vital registration system, it is an inaccurate tool. Alternatives to obtaining data about the spread and impact of HIV are cluster sampling, hospital surveillance of selected populations, anonymous testing of pregnant women or patients in sexually transmitted disease clinics. In Nairobi, a necropsy survey found that 16% had AIDs but 38% were HIV positive.
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PMID:What use is a clinical case definition for AIDS in Africa? 173 1

This article reports the findings of a study of HIV and STDs prevalence among long-distance truck drivers from East and Central Africa. Similar to prostitutes, truck drivers and a highly mobile population, characterized by having multiple sex partners. The researchers established a tent clinic at the Athi River Weighbridge Police Station near Nairobi, Kenya, where convoys of trucks stop for 3-5 days. 331 men from several East and Central African countries participated in the study. The participants completed a standard questionnaire about their medical history, knowledge, attitudes, and sex practices, and underwent a physical examination and blood test. Their ages ranged from 18-61 years, with a mean age of 31 years. 18% of the participants tested positive for HIV. Additionally, 4.6% tested positive for syphilis, and 4.5% and 4.3% suffered from urethral discharge ranked as the highest risk factor, followed by lack of circumcision. The study found no difference in the HIV prevalence rate between married and single men. The prevalence rate was far higher among Central Africans (31.75%) than among East Africans (16.65%), possibly explained by the hypothesis that says that HIV was first introduced in Central Africa, from where it spread to East Africa. Older drivers where more likely to be infected with HIV than younger drivers, with the age group of 40-49 having the highest prevalence rate. Researchers suspect that this is due to the fact that older drivers have been exposed longer and have more money with which to purchase sex. The report concludes that truck drivers constitute a high risk group, and should be targeted accordingly, with education and condom use campaigns.
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PMID:Long distance truck-drivers: 1. Prevalence of sexually transmitted diseases (STDs). 175 21


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