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

This pilot study aimed to determine the feasibility of a larger study of contraception and risk of HIV infection in women. We also measured risk factors for and occurrence of HIV infection in the participants. A cohort of 1537 seronegative women attending a family planning clinic in Nairobi, Kenya was enrolled and followed for up to 12 months per woman. HIV testing was done quarterly. A nested case-control analysis was done with seroconverting women (cases) and 3 matched controls per case, who had detailed interviews and received physical examinations and STD tests. The prevalence of HIV at enrollment was 6.1%; seropositive women were excluded from further analysis. The 12-month life-table cumulative incidence of HIV was 2.1 per 100 women (95% confidence interval [CI] 1.1-3.2). In the nested case-control analysis (17 cases and 51 controls), the crude odds ratio of HIV infection comparing oral contraceptive (OC) users with other women was 3.5 (95%) CI 0.8-21.5), which persisted after control for single confounders at a time. The putative association between OC use sand HIV infection is critical to public health policy, yet no study has been conducted specifically to measure it, yielding weak and conflicting evidence. We intend to conduct a larger study with a similar design as the current pilot study, which confirmed the feasibility of a more definitive project.
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PMID:Contraceptive use and HIV infection in Kenyan family planning clinic attenders. 865 17

In Kenya, the National Leprosy Tuberculosis Programme (NLTP) used previously reported data from Nairobi to compare the cost-effectiveness and total costs of a hypothetical strategy with three intervention strategies for the prevention and management of severe skin reactions caused by thiacetazone in treating HIV-positive patients with tuberculosis (TB). The hypothetical strategy was continued use of thiacetazone despite adverse skin reactions. The intervention strategies included patient education about possible side effects of anti-TB drugs (discontinue use if skin rash develops, report situation to clinic, replace thiacetazone with ethambutol when other skin diseases have been excluded), abandonment of thiacetazone and replacement with ethambutol, and HIV testing and pre- and post-test counseling. NLTP currently used the education strategy. It assumed a mortality rate of 5%. When the HIV prevalence rate is 1-90%, the education strategy is the most cost-effective strategy. In terms of total costs, the education strategy was also the most inexpensive strategy regardless of the HIV prevalence. At an HIV prevalence rate greater than 65%, the abandonment of thiacetazone strategy was the cheapest strategy. When the assumed mortality rate was 3%, the cost per averted death for the education strategy was reduced from about US$120 to about US$80 and the education strategy became the most cost-effective strategy over the entire range of HIV prevalence. In addition, the cost of HIV testing significantly increased the cost per averted death. Thus, the findings of this study are truly sensitive to different program conditions. Based on these findings, the authors recommended that the education strategy be applied with a range of HIV prevalence of 1-45%, that HIV testing be applied with a range of 46-72%, and that total abandonment be applied with an HIV prevalence greater than 72%.
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PMID:Cost-effectiveness and total costs of three alternative strategies for the prevention and management of severe skin reactions attributable to thiacetazone in the treatment of Human Immunodeficiency Virus positive patients with tuberculosis in Kenya. 873 10

During January-March 1994, in Nairobi, Kenya, the sera of pre-university students, suspected AIDS/advanced HIV-infection cases, and blood donors were screened for HIV-1 antibodies at the Virus Research Centre. All confirmed HIV-1 positive samples were categorized according to the patient's clinical status. A self-made ELISA was obtained from an established panel of HIV-1 V3 loop peptides and derived from seven isolates (MN and HXB2 [North American strains], SC, CDC4, Z2 and Z6 [African strains], and ELI). The sera of the 22 confirmed HIV-1 negative students were used as negative controls. There were 207 confirmed HIV-1 cases (95 blood donors and 112 suspected AIDS/advanced HIV-infection cases). 64 (31%) and 112 (54%) samples reacted to at least 3 strains and no more than 2 strains, respectively. The remaining 31 (15%) samples did not react to any of the 7 peptide strains. Samples with CD4 cell counts greater than 500 x 1 million reacted significantly to more peptide strains than those with CD4 counts below 200 x 1 million (88% vs. 7%). Reactivity to specific strains were 21.5% for MN, 19.1% for Z2, 17.2% for HXB2, 11.5% for SC, 6.2% for CDC 4, 5.5% for Z6, and 3.8% for ELI. Anti-HXB2 antibodies were more common in blood donors than suspected AIDS/advanced HIV-infection cases (22% vs. 13%). AIDS/advanced HIV-infection cases were more likely to have no antibodies than blood donors (21% vs. 7%). A significant association existed between the number of peptide strains a patient could react to and the clinical state (p 0.01). Specifically, 77% of samples with no V3 antibodies to the seven strains had AIDS or advanced HIV infection while 55% of those which had cross reactivity with three or more strains were asymptomatic. Further research is needed to better understand this correlation. These findings suggest that use of strain specific peptides may be a sensitive and easier method for use for molecular epidemiological purposes.
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PMID:Serological investigation of HIV-1 variant subtype strains in transmission in Nairobi. 875 45

Researchers conducted a retrospective analysis of stool specimens from 646 adult patients and of blood cultures from 2738 adult patients to examine the etiology of opportunistic infection in HIV-positive individuals in Nairobi, Kenya, and to compare this etiology with the range of pathogens causing disease in the HIV-negative population. Adults at least 15 years old contributed the stool and blood samples that were received at the Wellcome Trust-Kenya Medical Research Institute during 1988-92. The 415 significant blood culture isolates comprised 192 from 1785 HIV-negative patients and 223 from 953 HIV-positive patients. The most frequently detected pathogens in blood included Streptococcus pneumoniae (58 in HIV-positive cases and 25 in HIV-negative cases) and Salmonella typhimurium (56 in HIV-positive cases; 5 in HIV-negative cases). There were 233 significant stool isolates, 211 from 531 HIV-positive patients and 22 from 115 HIV-negative patients. 20 blood cultures and 21 stool cultures had more than 1 significant pathogen. The most commonly detected organisms in the stools were Shigella flexneri (49 for HIV-positive cases and 9 in HIV-negative cases), S typhimurium (40 in HIV-positive cases and 3 in HIV-negative cases), and Cryptosporidium parvum (45 in HIV-positive cases and 0 in HIV-negative cases). With two exceptions, the spectrum of pathogens associated with infection in HIV-positive patients was the same as that for HIV-negative patients. Physicians should consider this when they investigate and manage febrile illness with or without diarrhea in an HIV-positive patient.
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PMID:Microbiology of HIV associated bacteraemia and diarrhoea in adults from Nairobi, Kenya. 876 Sep 61

Although significant bacteriuria and urinary tract infection are more common in immunocompetent women than men, studies linking HIV immunosuppression with an increased risk of developing urinary infection have so far only been carried out in men. We therefore examined the relationship between bacteriuria and HIV status and CD4+cell count in a relatively homogeneous cohort of female commercial sex workers (CSW) attending a community clinic in Nairobi. Two hundred and twenty-two women were enrolled, and grouped according to HIV status and CD4 count. Group 1 were HIV seronegative (n = 52); Group 2 were HIV seropositive with CD4 + counts above 500 x 10(6)/l (n = 51); Group 3 were HIV seropositive with CD4 + counts between 201 and 500 x 10(6)/l (n = 67); Group 4 were HIV seropositive with CD4+counts below 200 x 10(6)/l (n = 52). Clinical signs and symptoms were noted and mid-stream specimens of urine obtained for culture and sensitivity. Overall 23% (50/222) had significant bacteriuria. The rates in each group respectively were 25%, 29%, 19% and 23% and there was no significant association between bacteriuria and HIV status; or between bacteriuria and level of immuno-suppression as indicated by CD4 + count. Overall 19% (30/222) of women had symptoms (frequency; dysuria; loin pain; smelly urine) or signs (fever; loin tenderness) compatible with urinary tract infection. However there was no significant association between symptoms or signs of infection and bacteriuria or HIV status. A typical range of pathogens, predominantly Enterobacteriaceae, were isolated and there were high rates of resistance to commonly used antimicrobials as well as 10% resistance to ciprofloxacin. Although high rates of significant bacteriuria can occur in highly sexually-active women, this appears unrelated to HIV infection or the level of HIV-related immunosuppression and is generally asymptomatic or clinically indistinct.
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PMID:Bacteriuria in a cohort of predominantly HIV-1 seropositive female commercial sex workers in Nairobi, Kenya. 884 92

Safer sex in the context of HIV/AIDS control in Kenya has mainly been promoted through the encouragement of condom use. In this strategy, safer sex is treated as though it is synonymous with condom use. This paper, which is based on ethnographic data drawn from a sample of 29 heterosexual HIV-positive patients presenting in four specialized treatment clinics in Nairobi, questions this assumption by examining some particular ways in which risks of HIV/AIDS are socially constructed, and how these perceptions have informed lay experiences of safer sex in Nairobi. The paper further examines the juxtaposition of common-sense and biomedical knowledge in producing socially meaningful experiences of safer sex. The implications of these lay safer sex constructions and experiences for government-sponsored HIV/AIDS control programmes and policies are discussed.
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PMID:Lay perceptions of risk of HIV infection and the social construction of safer sex: some experiences from Kenya. 889 7

Male patients (mean age, 28 years) attending a sexually transmitted disease clinic in Nairobi, Kenya, for either urethritis (276 controls) or a genital ulcer (607 cases) were compared with respect to sexual behavior, presence of HIV-1 antibody, and circumcision status. Only 164 men were not circumcised. Circumcised men reported more life-time sex partners than uncircumcised men (19 vs. 10, p 0.01). Patients were followed up for 196 days to explore the risk factors for incident genital ulcers and HIV-1 seroconversion. On average, 2.66 follow-up visits per patient were recorded. 28 men seroconverted to HIV-1 during follow-up. 61% of the ulcer patients reported sex workers as the likely source of their infection, whereas 58% of the urethritis patients did so. Multiple logistic regression variables of marital status, age, and genital ulcer in the past were used to examine the relationship among these variables. Ulcer in the past was a significant predictor of a current ulcer (p 0.01) and higher age was significantly associated with HIV-1 seropositivity (p 0.01). At entry, being married was associated with higher prevalence of HIV-1 (odds ratio [OR] = 1.76) and genital ulcers (OR = 1.42). Lack of circumcision was associated with both HIV-1 infection (OR = 4.67) and the presence of a genital ulcer (OR = 2.3). 68 men acquired a new ulcer during follow-up. HIV-1 seropositivity at enrolment was significantly associated with genital ulcer reinfection (relative risk = 3.63 by Cox's regression). Genital ulcers were also associated with HIV-1 infection (OR = 1.87) independent of circumcision status. On follow-up, HIV-1 seropositivity was associated with incident genital ulcers. The association between genital ulcers and HIV-1 infection may be more complex than ulcers' simply being a risk factor for HIV-1 infection: either HIV-1 infection may increase the risk of acquiring a genital ulcer or HIV-1 infection and genital ulcers may have some unknown risk factor in common.
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PMID:Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status. 894 Jun 69

The authors characterized HIV-1 subtypes from 17 seropositive individuals in Nairobi and Mombasa, Kenya. 71% of the viruses were clade A and 29% were clade D. The most divergent clade A isolate identified in the study, Q45-CxA, grouped closely with two other taxa previously reported as having no distinct clade affiliation. These findings may therefore signal the emergence of an outlier group of clade A variants or a new subtype of HIV-1. The evaluation of transitions, transversions, and specific character state changes indicated that mutations characterizing V2 differed from those in V3 for clade A and clade D isolates. Comparison of the secondary structural characteristics of the V1-V3 region between a clade A and a clade D virus revealed conservation of motifs.
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PMID:Phylogenetic evaluation of Kenyan HIV type 1 isolates. 910 Sep 91

A 3-year (1989-92) prospective study of 587 HIV-positive and 132 HIV-negative commercial sex workers in Nairobi, Kenya, revealed substantial recent transmission of tuberculosis in the HIV-infected group. The cohort was enrolled at a community clinic that provides counseling, sexually transmitted disease services, and free condoms. In HIV-positive women, 49 incident and 4 recurrent episodes of tuberculosis were diagnosed during the study period; there were no tuberculosis cases among HIV-negative women. The overall incidence rate of tuberculosis was 34.5/1000 person-years among HIV-positive women. 20 incident cases (41%) met the clinical case definition of primary disease. DNA fingerprint analysis of strains from 32 incident cases suggested 10 women (28%) may have had recently transmitted disease. 3 of 10 women who were initially purified protein derivative (PPD) skin test-negative became PPD-positive. Clinical presentation, tuberculin skin testing, and strain clustering data all independently suggested that substantial Mycobacterium tuberculosis transmission was occurring in HIV-infected prostitutes during the study period. As many as 26 (53%) of the 49 patients with incident disease may have recently acquired tuberculosis and DNA fingerprint analysis identified 2 (50%) of the 4 recurrent tuberculosis episodes as reinfection. These findings challenge the assumption that tuberculosis in HIV-infected individuals represents reactivation of latent endogenous infection.
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PMID:Recent transmission of tuberculosis in a cohort of HIV-1-infected female sex workers in Nairobi, Kenya. 918 17

To test the hypothesis that antituberculous drug disposition is altered in patients with AIDS, we studied the steady-state pharmacokinetics of isoniazid (300 mg/d), rifampin (600 mg/d), and pyrazinamide (1,500 mg/d) in 29 adults (14 patients infected with human immunodeficiency virus [HIV] and 15 non-HIV-infected patients) with tuberculosis in Nairobi, Kenya. Intestinal integrity was assessed with xylose. Neither HIV infection nor diarrhea accounted for the interpatient variability in the area-under-the-plasma concentration vs. time curve (AUC), the maximum concentration, or the terminal half-life (t1/2) of isoniazid, rifampin, and pyrazinamide. No significant association between HIV infection or diarrhea and pharmacokinetics was seen for any of the compounds. In addition, neither the AUC nor the t1/2 of any of these drugs reflected interpatient differences in CD4 lymphocyte counts. Xylose absorption was uniformly low. We did not demonstrate that HIV infection, diarrhea, or CD4 lymphocyte counts contributed significantly to the variability in pharmacokinetics of isoniazid, rifampin, and pyrazinamide in TB patients in Nairobi.
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PMID:Pharmacokinetics of antimycobacterial drugs in patients with tuberculosis, AIDS, and diarrhea. 924 44


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