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

Between October 1989 and May 1991 in Kenya, clinicians interviewed and took cervical cultures from 4404 women attending 2 periurban family planning clinics in predominantly lower socioeconomic areas of Nairobi to determine risk factors for sexually transmitted diseases (STDs) among low-risk women. Most women were married and/or had only one sexual partner in the past year. The STD prevalence rates were 3.2% for gonorrhea, 1.9% for syphilis, 5.2% for trichomonas, and 4.9% for HIV infection. The crude analysis showed that unmarried status and at least 2 sexual partners in the last year were significantly correlated with each STD. When the researchers controlled for each disease and for other risk factors, however, neither unmarried status nor at least 2 sexual partners were associated with the STDs. The population attributable risks (PARs) for unmarried women were 9.7% for gonorrhea, 9.1% for syphilis, and 15.9% for trichomonas. The PARs for more than 1 sexual partner were 7.7%, 7.2%, and 7.4%, respectively. These PARs were relatively low due to the considerable proportion of married and monogamous women in the sample. HIV seropositivity was the most significant predictor of gonorrhea, syphilis, and trichomonas infections (odds ratio = 1.9-3.4). The pelvic examinations of most women who had microbiological evidence of an STD were normal. The clinical diagnostic algorithms for STDs in the study used the most readily accessible and significant risk factors and physical examination findings. They had a relatively high specificity (76 - 99%) but low sensitivity ( 1 - 38%). These findings showed that none of the risk factors or the physical examination could be sufficiently used to predict an STD diagnosis. They also indicate the need for inexpensive diagnostic tests to identify and treat women at a relatively low risk of STDs in family planning and other clinics.
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PMID:Risk factors for gonorrhoea, syphilis, and trichomonas infections among women attending family planning clinics in Nairobi, Kenya. 803 77

HIV-seropositive patients respond to rifampicin-containing anti tuberculosis (TB) regimens as well as HIV-seronegative patients. In Nairobi, Kenya, 90% of HIV-positive patients who suffered a recurrence of TB first received a non-rifampicin-containing regimen. The overall unadjusted recurrence rate for HIV-positive patients was 16.7% while it was .5% for HIV-seronegative patients. An earlier, similar study in Zaire also showed a higher recurrence rate in HIV positive patients. A study in the US found a low recurrence rate among HIV-positive patients on rifampicin-containing regimens. A possible explanation for the higher recurrence rates may be that the thiacetazone-containing regimen is not as potent as the rifampicin containing regimen. Another possible explanation may be that no one knows the optimum duration of therapy for HIV-infected patients. 70% of HIV-positive patients in nairobi who suffered a recurrence of TB experienced a cutaneous-hypersensitivity reaction, resulting in a change in therapy and maybe affecting compliance. The researchers of the Nairobi study used DNA fingerprinting to determine whether the patients truly relapsed or were reinfected (cultures were available from only 3 HIV-positive patients). 1 patient was reinfected by a different strain of Mycobacterium tuberculosis. 4 of 17 AIDS patients in New York City were reinfected with a different multidrug resistant strain of M. tuberculosis. Reinfection is more likely to happen in sub-Saharan Africa where TB an HIV are very prevalent. Physicians cannot accurately determine a treatment regimen in HIV-infected patients in an area of high prevalence of TB. Thus, we need to determine reinfection rates in HIV infected patients to plan a response.
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PMID:Tuberculosis recurrence in Africa: true relapse or re-infection? 810 71

The case notes of patients with blood cultures positive for enterobacteriaceae were examined retrospectively over a 6-month period in Parirenyatwa Hospital, Harare, Zimbabwe. Speciation was possible for Salmonella typhi and shigellae only. Nontyphoidal salmonellae were serotyped. Salmonella or shigella bacteremia was identified in 51 patients. There were 14 isolates of S. typhi, 32 isolates of nontyphoidal salmonellae, and 5 isolates of shigellae species. The case notes of 38 patients could be identified for review, and of these HIV serology was available for 15 seropositive and 15 seronegative patients. The male to female ratio was approximately 3:1 for both groups and the mean age was 29.7 +or- 21. Nontyphoidal bacteremias as compared with typhoid fever were strongly associated with HIV seropositivity [p 0.01]. 3 out of 8 HIV-negative patients with nontyphoidal bacteremia had another underlying immunosuppressive disease [2 had myeloma and 1 patient had cirrhosis with complicating hepatoma]. 2 patients with nontyphoidal bacteremia whose HIV status was unknown also had another immunosuppressing disease [acute myeloid leukemia and idiopathic pancytopenia]. 13 out of 15 HIV-positive patients showed other signs of HIV infection [oral candida, herpes zoster, persistent generalized lymphadenopathy]. 3 out of 11 patients [27%] with typhoid died, while 11 out of 27 patients [40.7%] with nontyphi bacteremia died. Most strains of S. typhimurium were included in serogroup B, which accounted for 37% of nontyphoidal isolates. Earlier studies identified invasive salmonellosis in patients with other AIDS defining diseases. In Nairobi clinical features of HIV infection were found in 64% of bacteremic HIV-positive patients, but only 28% of patients fulfilled the CDC clinical case definition for AIDS. A more recent study from Nairobi demonstrated that S. typhimurium bacteremia is a common cause of intercurrent infection in HIV-positive tuberculous patients.
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PMID:Salmonella and shigella bacteraemia in Zimbabwe. 813 Nov 97

In Belgium, the Department of Infection and Immunity of the Institute of Tropical Medicine in Antwerp modified an experimental enzyme immunoassay (EIA) for the detection of serum IgG to Hemophilus ducreyi to develop EIAs for detection of anti-H. ducreyi IgA and IgM antibodies. They tested the modified EIA on sera from people in Nairobi, Kenya; Kigali, Rwanda; Banjul, The Gambia; and Bangkok, Thailand, who had a sexually transmitted disease. The EIA was able to identify correctly those who did not have anti-H ducreyi IgA, IgG, and IgM antibodies in 97%, 92%, and 99% of cases, respectively. Among people with a genital ulceration for more than 8 days, it was able to identify correctly those who had IgA, IgG, and IgM antibodies in 88%, 93%, and 78% of cases, respectively. 95% of all culture-proven chancroid patients tested seropositive for at least 1 antibody type. The sensitivity of IgG and IgA EIAs was significantly enhanced in patients with culture-proven chancroid who were older than 24 years old (p .01). HIV seropositive people from Kigali who had culture-proven chancroid had higher anti-H. ducreyi IgG seropositivity rates (but not IgA and IgM seropositivity rates), than did HIV seronegative chancroid people from Kigali (p .05). The increased IgG seropositivity rate was not related to higher antibody titers, however, suggesting that HIV infection modifies the response to H. ducreyi. These results show that the 3 EIAs hold promise as a means to study the kinetics of antibodies and the epidemiology of chancroid.
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PMID:Enzyme immunoassays (EIAs) for the detection of anti-Haemophilus ducreyi serum IgA, IgG, and IgM antibodies. 814 Apr 87

Using data on tuberculosis (TB) index cases over age 15 years seen at the Infectious Diseases Hospital in Nairobi and the Ngaira Avenue Chest Clinic over September 1, 1989 and October 10, 1990, and their contacts, the authors determined the infectiousness of culture-confirmed pulmonary TB in patients infected with HIV-1. Comparing the incidence of TB and the prevalence of tuberculin skin test positivity among the household contacts of HIV-1 positive and negative cases with pulmonary TB found HIV-1-associated pulmonary TB to be no more infectious than TB alone. The presence of HIV-1 in a community therefore does not require a change in the management of contacts of patients with pulmonary TB.
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PMID:The effect of human immunodeficiency virus type-1 on the infectiousness of tuberculosis. 816 61

Acute salpingitis complicating cervical gonococcal infection is a significant cause of infertility. Relatively little data are available concerning the pathophysiologic mechanisms of this disease. A cohort of 243 prostitutes residing in Nairobi were followed between March 1985 and April 1988. Gonococcal cultures were performed at each visit, and acute salpingitis was diagnosed clinically. Serum at enrollment was tested by immunoblot for antibody to gonococcal outer membrane proteins. 8.6% (146/1689) of gonococcal infections were complicated by salpingitis. Increased risk of salpingitis was associated with younger age, shorter duration of prostitution, HIV infection, number of gonococcal infections, and episodes of nongonococcal salpingitis. Rmp antibody increased the risk of salpingitis. Antibody to Opa decreased the risk of salpingitis. By logistic regression analysis, antibody to Opa was independently associated with decreased risk of gonococcal salpingitis (adjusted odds ratio [OR], 0.35; 95% confidence interval [95%CI], 0.17-0.76); HIV infection (adjusted OR, 3.5; 95% CI, 0.96-12.8) and episodes of nongonococcal salpingitis (adjusted OR, 3.4; 95% CI, 1.8-6.4) were independently associated with an increased risk of salpingitis. Antibody to Opa appears to protect against ascending gonococcal infection, perhaps by interfering with Opa mediated adherence and endocytosis. The demonstration of natural immunity that protects against upper genital tract infection in women suggests that a vaccine to prevent gonococcal salpingitis is possible.
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PMID:Antibodies to opacity proteins (Opa) correlate with a reduced risk of gonococcal salpingitis. 816 73

The current literature on the transmission of HIV and the use of oral contraceptives (OCs), injectables, IUDs, spermicides, and the female condom was reviewed. Some of the methodological difficulties involved study design (observational studies, cross-sectional, case control, and prospective studies) and confounding factors (age, marital status, sexual partners). The impact of OC use on HIV transmission is likely to be minor, but some factors contributing to transmission include cervical ectropion, which enhances HIV transmission. Nevertheless, in a 1990 Nairobi study of 4404 women no such association was detected. Sexually transmitted diseases (STDs) have been risk factors in HIV transmission. OCs that decrease irregular bleeding may protect against HIV. Progestin-only pills could act on the risk of HIV transmission by thickening cervical mucus and thinning the vaginal epithelial layer. 21 epidemiological studies were identified on the use of OCs and transmission. Except for a 1990 Nairobi study among prostitutes none of them reported a significant association between OC use and HIV seropositivity. Injectables (Depo Provera) could theoretically increase HIV transmission, but no such conclusive evidence has surfaced. Increased risk of transmission or seropositivity has been reported with IUD use, but this needs confirmation by prospective studies. Among spermicides the nonoxynol-9 sponge slightly increased HIV seroconversion in 139 sex workers in Nairobi in a 1992 study. However, this trial was contradicted by other prospective studies conducted in Cameroon and Zambia. Nonoxynol-9 kills HIV but also damages the cervical and vaginal mucosa enhancing HIV transmission. In 1992 in vitro activity in 26 out of 131 other spermicides screened inhibited HIV. The female condom was tested in 104 women in a 1993 prospective study in the US and no recurrences of trichomonas occurred in 20 women who used it consistently over a 6-week period. More prospective epidemiological studies are needed, and the risk of HIV infection should be part of counseling on contraceptives.
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PMID:Contraceptive methods and the transmission of HIV: implications for family planning. 820 68

By using routinely collected data and results from research studies at the Infectious Diseases Hospital (IDH), Nairobi, we have begun to determine the scale of the increase in resource utilisation and treatment costs for tuberculosis control services caused by the HIV epidemic. New cases of tuberculosis registered annually at the IDH rose 61%, from 447 in 1985 to 720 in 1990. HIV seroprevalence among patients with tuberculosis rose from 7.5% in 1986 to 42% in 1990. The inpatient mortality rate rose from 8.4% in 1985 to 16.8% in 1989, but fell to 13.5% in 1990. HIV-positive patients were admitted to hospital on 2 or more occasions more often than HIV-negative patients (Relative risk (RR) = 2.46, 95% confidence intervals (CI), 1.1-5.7), but average duration of admission was similar for the 2 groups. Significantly more HIV-positive patients were prescribed antibiotics, antifungal agents, antidiarrhoeal agents, analgesics and corticosteroids than HIV-negative patients. Microbiological investigations, apart from those for tuberculosis, were performed more commonly among HIV-positive patients (RR = 2.0, 95% CI 1.0-4.2). Using this data, the average cost of ideal drug therapy, including antituberculosis drugs and treatment for intercurrent infections and other complications, was estimated using 1992 prices (ECHO, Coulsdon Surrey, UK). The costs were US$16.62 and US$32.94 for HIV-negative patients using 'standard' therapy (2STH/10TH) and short course therapy (2SHRZ/6TH) respectively, and US$41.18 for HIV-positive patients using a short-course regimen without thiacetazone (2EHRZ/6EH). The HIV epidemic is causing both an increase in the numbers of patients requiring treatment and an increase in the average cost of treatment per patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The impact of HIV on resource utilization by patients with tuberculosis in a tertiary referral hospital, Nairobi, Kenya. 821 80

Tuberculosis (TB) is a common complication of HIV in Africa. A 1988-89 study further confirmed that considerable morbidity and mortality from acute bacterial infection occurred in HIV patients. It has also been found that anti-TB therapy seems to be as effective in HIV-positive as in HIV-negative TB patients. This paper reports on the level and nature of infectious morbidity suffered by HIV-positive patients receiving treatment for TB. The assessment is based upon a sample of inpatients and outpatients at the Infectious Diseases Hospital in Nairobi. Patients were aged 15 years and older, with a TB diagnosis presenting with 1 or more of a series of clinical features. 642 morbid events were seen in 398 patients: 235 HIV-positive patients had 438 event and 163 HIV-negative patients had 204 events. 18% of the HIV-positive patients versus 6% of the HIV-negative patients were bacteremic. Salmonella typhimurium and Streptococcus pneumoniae were most commonly isolated from sera, while fecal specimens were obtained more commonly from HIV-positive patients and often contained bacterial pathogens. The authors conclude that many causes of morbidity in patients with TB and HIV are not due to TB or anti-TB therapy and will not be identified without microbiological investigation. These results suggest that even with effective anti-TB chemotherapy HIV-positive patients will remain or become unwell.
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PMID:Infection and morbidity in patients with tuberculosis in Nairobi, Kenya. 828 Apr 13

Women attending 2 family planning clinics in Nairobi, Kenya, were enrolled in a study of risk factors for HIV infection between October 1989 and May 1991. Data were obtained using a structured questionnaire on social, demographic, medical, and sexual behavior. During pelvic examination, were obtained specimens, for a Papanicolaou (PAP) smear and for sexually transmitted disease (STDs). 4058 women had an interpretable smear (with both squamous and endocervical cells present). 82 of the 4058 (women 2.0% had cytological evidence of cervical intraepithelial neoplasia (CIN): 58 had CIN-I, 23 had CIN 11, and 1 had CIN III. Single women were at a reduced ask for CIN (multivariate odds ratio = OR, 0.25; 95% confidence interval = CI, 0.07-0.86). There was no consistent association between number of pregnancies and CIN, although there was some evidence of a protective effect of later age at first pregnancy (P for linear trend = 0.07 and 0.35 in the crude and multivariate analyses, respectively). Age at first intercourse of at least 19 years compared with an age of 16 years of under was protective against CIN (OR, 0.45; 95% CI, 0.20-0.97). Having more than one lifetime sex partner increased the risk of CIN (OR, 1.60; 95% CI, 0.86-2.99). Positive syphilis serology was associated with a doubling of risk (OR, 2.28; 95% CI, 0.6%-7.63). Oral, intrauterine, or injectable contraception was not significantly associated with CIN. Ten (4.9%) of the 205 HIV-seropositive women had CIN, compared with 72 (1.9%) of the 3853 HIV-seronegative women (OR, 2.69; 95% CI, 1.29-5.49). This positive association remained after controlling for sexual behavior and other risk factors. On clinical examination, enlarged cervical, axillary, or inguinal lymph nodes were detected in 5.1% of the HIV-seropositive women compared with 1.7% of the HIV-seronegative women. CIN was more common among 204 HIV-seropositive women with symptoms or signs consistent with immunodeficiency (weight loss, fever, diarrhea); however, none of these associations reached statistical significance.
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PMID:The relationship between HIV infection and cervical intraepithelial neoplasia among women attending two family planning clinics in Nairobi, Kenya. 831 80


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