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

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

Heterosexual transmission of the human immunodeficiency virus (HIV) appears to occur readily in Africa but less commonly in North America and Europe. We conducted a case-control study among men attending a clinic for sexually transmitted diseases in Nairobi to determine the prevalence of HIV infection and the risk factors involved. HIV antibody was detected in 11.2 percent of 340 men who enrolled in the study. Reports of nonvaginal heterosexual intercourse and homosexuality were notably rare. Recent injections and blood transfusions were not associated with HIV infection. Travel and frequent contact with prostitutes were associated with HIV seropositivity. Men who were uncircumcised were more likely to have HIV infection (odds ratio, 2.7; P = 0.003), as were those who reported a history of genital ulcers (odds ratio, 7.2; P less than 0.001). A current diagnosis of genital ulcers was also associated with HIV seropositivity (odds ratio, 2.0; P = 0.028). Multivariate analysis revealed an independent association of genital ulcers with HIV infection in both circumcised and uncircumcised men. Uncircumcised men were more frequently infected with HIV, regardless of a history of genital ulcers. Our study finds that genital ulcers and an intact foreskin are associated with HIV infection in men with a sexually transmitted disease. Genital ulcers may increase men's susceptibility to HIV, or they may increase the infectivity of women infected with HIV. The intact foreskin may operate to increase the susceptibility to HIV.
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PMID:Human immunodeficiency virus infection among men with sexually transmitted diseases. Experience from a center in Africa. 339 82

The main aspects of the acquired immunodeficiency syndrome (AIDS) epidemic in Africa as of mid-1986 are discussed. In certain parts of Africa the disease appears to be widespread and fairly evenly divided between the sexes. Most of the AIDS patients have traveled a great deal and been very active sexually, even while traveling. Prostitutes in such large cities as Nairobi are heavily infected with HIV. Recognized routes of infection are: sexual transmission, blood transfusion, contaminated injection equipment, and mother to child. The pathology of AIDS involves the death of the helper cell type of T-lymphocytes, which increases the patient's susceptibility to infections and tumors. There is some evidence that the HIV epidemic originated in central Africa, possibly as a mutant of the green monkey fever virus, and gradually spread to Europe and the USA. Clinically, AIDS should be suspected with such symptoms as persistent unexplained fever, chronic diarrhea, lymphadenopathy, severe wasting, and itching skin lesions, primarily on the extremities. Definitive symptoms include such opportunistic infections as candida esophagii, cryptococcus, severe varieties of herpes simplex, pneumocystis carinii pneumonii, disseminated strongyloids, cerebral toxoplasmosis and a typical mycobacteria. Serological diagnostic tests include enzyme linked immunosorbent assay (ELISA) and Western blot, both of which require advanced equipment. No treatment for AIDS is known; management should concentrate on preventing opportunistic infection.
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PMID:[AIDS in Africa]. 364 40

Studies from Kenya have reported rapid clinical disease progression among HIV-infected professional sex workers. The reasons for this rapid decline are unknown. To better understand factors influencing the course of disease, HIV-1 disease progression was explored in terms of declines in CD4 counts. Two samples from Nairobi, Kenya, were studied, one from a cohort of female sex workers and another, as a comparison group, from mothers enrolled in an HIV-1 vertical-transmission study. A Markov model was used to analyze transitions between HIV-1 disease stages as defined by CD4 counts. It appears that sex workers experience a rapid decline in CD4 counts, consistent with earlier findings of rapid clinical disease progression among individuals in this group. The rate of decline in CD4 counts among the mothers appears to be lower. It is speculated that either intensive exposure to sexually transmitted pathogens or infection with several strains of HIV-1 may account for the rapid disease progression among female sex workers.
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PMID:Comparison of the declines in CD4 counts in HIV-1-seropositive female sex workers and women from the general population in Nairobi, Kenya. 758 42

During January 1989-March 1992 in Kenya, health workers at two prenatal clinics in Nairobi tested 7893 pregnant women for HIV infection. They invited the HIV-positive women to participate in a study of HIV infection among pregnant women. The women gave informed consent to participate in the study, which included counseling before and after the test on HIV and other sexually transmitted diseases (STDs). More than 80% were in a stable marriage. During the first 2 years of the study, more than 90% of the 5274 pregnant women returned to the clinic to learn their test result. 6.1% tested HIV positive. About 25% of the HIV-positive women dropped out of the study before counseling. Only 27.2% told their partner their HIV status. 8.6% returned to the clinic with their partner for HIV testing and counseling. 5.9% of all HIV-positive women suffered violence after HIV counseling. 13 of 19 of these women had communicated their test result to their partner. The high rate of violence forced the staff to change its counseling policy. During the next 2 years of the study, they continued to provide information on HIV and STDs, but they did not set up an appointment for the HIV test results. They informed the 2619 women that they could come any morning for their results or collect them at their next prenatal visit. 11.9% tested positive. Only 35% of the HIV- positive women inquired about their test result. Violence against HIV positive women happened in 1.9% of cases. HIV-positive women and HIV-negative women requested the results of the HIV test at the same rate, suggesting that they did not consider themselves at special risk. These findings show that, even after informed consent, participants in a study of perinatal HIV transmission and intervention should have the right to not be informed about the HIV test results, since the risk of increased violence and loss of security may outweigh the benefits of the study.
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PMID:The right not to know HIV-test results. 776 18

The authors report findings from a prospective study conducted to investigate the relationship between the carriage of antibiotic-resistant Staphylococcus aureus and infection with HIV. 554 pernasal swabs were taken during a six-month period from 554 adult patients attending three outpatient clinics and from inpatients in a hospital in Nairobi, Kenya. 22% of swabs yielded Staphylococcus aureus, with significantly higher carriage in HIV-positive patients than in HIV-negative patients: 27% and 17%, respectively. Antimicrobial resistance rates determined for 110 isolates were 91% for penicillin, 72% for tetracycline, 8% for erythromycin, 3% for methicillin, 5% for gentamicin, and 0% for chloramphenicol. Genetic analysis identified plasmids in the range of 24-42 MDa associated with B-lactamase production and plasmids in the range of 3-5 MDa associated with resistance to tetracycline, erythromycin, and trimethoprim. All nine erythromycin-resistant strains were from HIV-positive patients. There was a significant association of tetracycline resistance with HIV seropositivity.
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PMID:Nasopharyngeal carriage of Staphylococcus aureus and carriage of tetracycline-resistant strains associated with HIV-seropositivity. 772 50

The sexual transmission of human immunodeficiency virus type 1 (HIV-1) continues at an alarming rate in sub-Saharan Africa despite the fact that awareness of AIDS is high. One explanation for this alarming rate may be that individuals do not believe that they are personally at risk for AIDS and are not sufficiently motivated to make changes in their behavior. We conducted a cross-sectional study of men with genital ulcer disease to assess their sexual behavior and their perceived risk of AIDS. We studied 787 men between the ages of 17 and 54 years who presented to a referral clinic for sexually transmitted diseases (STDs) in Nairobi, Kenya. Of these 787 men, 188 (24%) were infected with HIV-1. Awareness of AIDS was essentially universal in this population; however, only 64 men (8%) thought that they were personally at risk of developing AIDS. A logistic regression analysis found that men who believed they were personally at risk knew someone with AIDS (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.0-19.7), received information about AIDS from television or video (OR, 3.0; 95% CI, 1.7-5.5), or had previously had an STD (OR, 2.2; 95% CI, 1.2-4.1). Except for a modest increase in condom use, there was no significant difference in sexual behavior between the group who considered themselves to be at risk for AIDS and the group who did not consider themselves to be at risk. The results of this study challenge the current strategies on HIV/AIDS education and prevention for urban men in Kenya.
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PMID:Sexual behavior and perceived risk of AIDS among men in Kenya attending a clinic for sexually transmitted diseases. 781 63

Previous studies from Africa have been unable to identify disseminated Mycobacterium avium complex (MAC) infection in patients with advanced human immunodeficiency virus (HIV) infection. We performed mycobacterial blood cultures and CD4 counts on 48 symptomatic adults with advanced HIV infection admitted to the hospital in Nairobi, Kenya over 4 weeks in 1992. Fourteen patients had mycobacteremia; these patients had significantly lower CD4 counts than the patients with negative cultures (14/mm3 vs. 85/mm3; p < 0.01). Three patients (6%) were bacteremic with M. avium (mean CD4 count, 10/mm3) and 11 (23%) were bacteremic with Mycobacterium tuberculosis complex (MTB) (mean CD4 count, 15/mm3). Thus, M. avium bacteremia was detected significantly less frequently in the study population than MTB bacteremia (p = 0.04). The minimum rate for HIV-associated disseminated M. avium infection in patients admitted to the hospital in Nairobi was estimated to be approximately 1%. Patients with mycobacteremia died or were discharged home sick before the diagnosis was made. Disseminated M. avium does occur in adults with advanced HIV infection in sub-Saharan Africa, but is less common than disseminated MTB.
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PMID:Disseminated Mycobacterium avium infection among HIV-infected patients in Kenya. 783 2

87 newly diagnosed pulmonary tuberculosis (PTB) patients at the Infectious Diseases Hospital, Nairobi, Kenya, were recruited into the study. Only patients with acid fast bacilli on stained smears of expectorated sputum were considered to have PTB. Cases were presumed PTB when a negative sputum smear was obtained in a patient with clinical and radiographic features consistent with PTB. Heparinized peripheral venous blood from each patient was tested for antibodies to HIV-1 with the Dupont HTLV 111 and the Wellcozyme Diagnostics ELISA. Only samples seropositive with both ELISAs were considered HIV-1 seropositive. T-lymphocyte subpopulation was separated from mononuclear cells by centrifugation on a Ficoll-Hypaque gradient. There were approximately equal numbers of males and females (25 males and 24 females) in the HIV-1 negative group but as many as 26 males compared to 12 females in the HIV-1 positive group. The sex ratio in the HIV-1 negative was M/F; 1:0.96 and M/F; 1:0.5 in the HIV-1 positive group. The mean age of patients with HIV-1 (33.4 +or- 7.22) was significantly higher than those without HIV-1 (28.70 +or- 11.20; p0.001). The overall prevalence of HIV-1 was 44%; higher in men (30%) than in women (14%). The hemoglobin (12.0 +or- 2.6 gm HIV-1 negative; 12.0 +or- 1.4.0 gm HIV-1 positive) and total lymphocyte counts (2451.6 +or- 1036.7/cubic mm HIV-1 negative; 2020.9 +or- 1258.6/cubic mm HIV-1 positive) were not significantly different between the 2 groups. However, the white blood cell count was significantly higher in HIV-1 seronegative group (7273.5 +or- 4700/cubic mm) than in the HIV-1 seropositive group (5094.8 +or- 3494/cubic mm); p0.05). Patients with HIV-1 presented more often with lymphadenopathy, diarrhea and weight loss, whereas cough and fever were as common in HIV-1 positive as HIV-1 negative patients. Even though CD3, CD4, and CD8 counts were significantly lower in HIV-1 positive patients, the ratio of CD4/CD8 was not significantly different between the 2 groups.
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PMID:Clinical and immunological markers in Kenyan pulmonary tuberculosis patients with and without HIV-1. 783 58

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


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