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Query: UMLS:C0019693 (HIV)
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Trends in the incidence of HIV/AIDS infection among women in Sub-Saharan Africa suggest this population is increasingly at risk. Many of the same factors that have predisposed rural African women to ill health in the past now increase their vulnerability to AIDS, including poverty and malnutrition, uncontrolled fertility, and complications of childbirth. As men travel out from rural communities to urban centers in search of employment, their sexual contacts multiply; many will acquire the HIV virus and carry it back to infect wives at home. Women, too, are leaving rural areas for the promise of a better life in cities and commercial centers along the way. Their struggle for economic survival and personal autonomy has led many to form relationships with new sexual partners, with a consequent increase in HIV seroprevalence among women once considered at low risk of infection. This paper argues that AIDS prevention campaigns have not yet taken into account the cultural, social, and economic constraints on most African women's ability to comply with advice to limit partners and use condoms. The author proposes a research agenda to explore the meaning of AIDS and AIDS prevention in the sociocultural context of women's lives. A better understanding of how women, themselves, perceive and respond to current attempts to prevent the transmission of AIDS is an increasingly critical factor in the intervention process. Most important, it is a necessary first step toward their effective participation with men in the development of culturally relevant strategies for protecting themselves and their families.
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PMID:African women and AIDS: negotiating behavioral change. 173 58

Nutritional deficiencies have been documented to affect immune function. The present study indicates that vitamin B6 deficiency is prevalent in CDC stage III HIV-1-infected subjects, despite adequate dietary vitamin B6 intake. As vitamin B6 deficiency has been previously shown to affect immune function, these relatively asymptomatic HIV-1-infected patients were examined for evidence of a relationship between vitamin B6 deficiency and immune dysregulation. Vitamin B6 status in HIV-1-infected subjects was significantly associated with functional parameters of immunity [multivariate F(3,36) = 3.70, p less than or equal to 0.02]. Additional analyses indicated that overtly deficient participants exhibited significantly decreased lymphocyte responsiveness to the mitogens phytohemagglutinin and pokeweed, and reduced natural killer cell cytotoxicity, compared to subjects with clearly adequate vitamin B6 status (chi 2 = 8.78, df = 3, p less than 0.04). Vitamin B6 status was not related to immune cell subpopulations, e.g., CD4, CD8 cell number, or level of serum immunoglobulins. The results of this study indicate that while vitamin B6 status is not a primary etiological factor in HIV-1-related immunological dysregulation, it appears to be an important cofactor of immune function.
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PMID:Association of vitamin B6 status with parameters of immune function in early HIV-1 infection. 175 40

A protein profile has been monitored during human immunodeficiency virus (HIV) infection. The investigation concerned 60 patients suffering from acquired immunodeficiency syndrome (AIDS), 24 asymptomatic HIV-antibody seropositive subjects and 22 healthy HIV-antibody seronegative, individuals voluntary blood donors. Data show that retinol-binding protein, thyroxin-binding prealbumin and beta 2-microglobulin are already modified in HIV infection (p less than 0.05) whereas the other protein alteration becomes apparent during AIDS. These studies demonstrate that severe, but progressive malnutrition occurs in patients with AIDS. On the other hand nutritional abnormalities can be shown to have a deleterious effect upon the disease course as revealed by increasing alpha-1-acid glycoprotein and C-reactive protein levels for 60 to 70% of patients.
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PMID:[Inflammatory reaction markers and nutritional markers in HIV infection]. 177 13

Cholera asiatic is an acute infection of the intestinal tract through Vibrio cholerae bacteria causing diarrhea, dehydration, and kidney failure. It was discovered by Robert Koch in 1883 on his study trip in Egypt. Transmission is mostly through drinking of contaminated water and sometimes by consumption of infected food such as seafood. Cholera originates from southeast Asia, mainly India where it already appeared in ancient times. It spread from India in pandemic waves in the last few centuries throughout the world up to 1923 in Europe. Epidemics were nonetheless registered in India, China, Japan, Iran, and Egypt (1947). There was a pandemic in Peru in 1991 (caused by hyperinflation-induced malnutrition, contaminated water, and untreated sewage pouring into the sea) that also affected the neighboring countries, and small epidemics among Kurdish refugees and Bangladeshi catastrophe victims. On June 5, 1981 the deaths by atypical pneumonia of 5 homosexual men were reported to the Centers for Disease Control in Atlanta, Georgia, which was the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic caused by HIV. WHO's latest figures indicated a total of 366,455 AIDS patients in 162 countries, but a higher estimate of 1.4 million was more likely. As of April 1991 and estimated 8-10 million adults were infected with HIV, 6 million of them in Africa, south of the Sahel. In the next century 15-20% of the working population will die of AIDS leaving behind 10 million orphans. Tuberculosis has also been activated as an opportunistic disease of HIV infection. Up to 55% of African TB patients were also infected with HIV. Some predict that the AIDS pandemic will equalize the population growth by an average of 300,000 deaths/year.
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PMID:[Epidemics return and new ones are added]. 178 18

Infection of Human organism by Human Immunodeficiency viruses induces, after a shorter or a longer period, a complex immune Deficiency (ID) that has been named Acquired Immune Deficiency Syndrome (AIDS). Although the designation is not correct, it has been accepted by the scientific community. AIDS includes multiple clinical situations that have in common HIV infection and an almost constant ID, that at the end of natural course of infection manifestated by the presence of opportunistic infections and malignant tumors. HIV-1 and HIV-2 are slow RNA viruses with a common architecture and well known genomic organization. The characteristics that made HIV infectious agent n. 1 in XXth Century are their remarkable heterogeneity, close AA sequence homology between some of their proteins and relevant molecules in human beings: MHC molecules, IL-2, VIP, etc. and a strong affinity of gp 120 to CD4 receptor of T helper lymphocytes (T4), mononuclear phagocytes, natural killer cells, etc. all of them sharing a relevant role in normal immune response (IR). Affected in its cornerstones of cellular defense, human organism starts an immune defense through antibodies, cytotoxic T Lymphocytes (CTL) Natural Killer Cells (NK) antibody dependent cell cytotoxicity (ADCC), that fails. Activating immune system HIV turn that defense strategy to their own profit and enhanced replication. After an apparent latency period--in which the balance seems to favor the host--new viral variants arise due to high rate of HIV mutagenesis, that in turn stimulate immune system, induce new cycles of viral replication and new high virulent mutants, leading to the final collapse of Immune System.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Immunologic aspects of HIV infection]. 180 34

Researchers analyzed data on 667 patients admitted between March 9 and September 14, 1988 to the Kenyatta National Hospital in Nairobi, Kenya to verify the contribution of Salmonella and Shigella species to hospital acquired infections and to identify factors associated with admission and nosocomial infection. Laboratory personnel isolated Salmonella and Shigella in 12.5% (10% and 2.5% respectively) of the 360 patients with nosocomial diarrhea. Their overall prevalence was 3% and 2.5% respectively. These 2 bacteria were isolated from rectal swabs from 19 of the 27 hospital units. Most of the isolates were restricted to 5 units. All of the Salmonella isolates at admission were children under 13 years old (3.6% of 556 children). Shigella prevalence at admission was 2.5% for children and 3.6% for adults. The risk of nosocomial diarrhea caused by these 2 bacteria was much greater in children older than 6 months and younger than 6 years than in children of other ages (odds ratio [OR]=21.7; p=.006). The most significant variables which independently affected nosocomial diarrhea caused by these bacteria in children were recent antimicrobial therapy (OR=26.4; p=.001) and living in crowded homes (OR=1.2; p=.02). Another determinant was poor hair color indicating malnutrition (p=.03). Even though there were no significant differences between adults with nosocomial diarrhea caused by these bacteria and those with no nosocomial diarrhea, sharing a room with people with diarrhea, being in the hospital within the last 30 days, and being HIV-1 positive were factors that almost reached significance. In fact, 9 of their 22 (41%) adults with positive cultures of Salmonella were HIV=1 positive yet Salmonella was not isolated from any of the 70 HIV-1 positive patients at admission. Salmonella contributed greatly to nosocomial diarrhea at this hospital. The hospital should evaluate and redesign its control measures within available limited resources.
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PMID:Salmonella and Shigella gastroenteritis at a public teaching hospital in Nairobi, Kenya. 181 76

A fatal disease epidemic affected the Bentiu area in southern Sudan and led to a mass migration of the Nuer tribe searching for treatment. The initially available information revealed a high mortality rate due to a possible occurrence of tuberculosis, malaria, enteric fever or visceral leishmaniasis (VL). Serological screening of 53 of the most severely affected patients in an enzyme-linked immunosorbent assay (ELISA) or an improved direct agglutination test (DAT) revealed positivity for VL. In 39 of those patients, diagnosis was confirmed by identification of Leishmania donovani amastigotes in lymph node or bone-marrow aspirates. In a total of 2714 patients observed, 1195 (44.0%) had clinical symptoms suggesting VL: DAT positive titers (1:3200-greater than or equal to 1:12800) were obtained in 654 (24.1%), of whom 325 were confirmed parasitologically. Forty-two VL cases died before or during treatment, giving a mortality rate of 6.4%. Among the intercurrent infections diagnosed in the VL population (654), respiratory involvements (31.7%) and malaria (10.7%) were most prevalent. With the exception of four (0.6%), all other VL patients (509) responded readily to sodium stibogluconate. The factors initiating the outbreak are discussed. Malnutrition and nomadic movements to potential VL endemic areas appeared to be the most important. HIV infection as a possible predisposition seemed remote considering the clinical and epidemiological similarity to VL occurring in East Africa, adequate humoral response in DAT, and immediate positive response to specific anti-Leishmania chemotherapy.
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PMID:A killing disease epidemic among displaced Sudanese population identified as visceral leishmaniasis. 185 33

Case management strategies for the nutritional support of patients infected with the human immunodeficiency virus (HIV) are evolving as the disease becomes less rapidly fatal and more chronic. Nutritional status changes in advanced HIV infection are similar in many respects to protein-calorie malnutrition. Current clinical effort and research focuses on the beneficial effects of preserving lean body mass and keeping asymptomatic patients in good nutritional status by preventing micronutrient deficiencies and by treating preexisting nutritional problems rather than attempting to intervene late in the disease's course, after secondary malnutrition has already developed. Nutrition support and intervention trials only late in the disease process have not been promising in reversing weight loss once it has occurred. Special diets, such as lactose- or gluten-free diets, may be helpful in some cases as asymptomatic treatment of some opportunistic infections, and such measures may slow additional losses. However, secretory diarrhea, which often seems to be inherent to the disease itself, is not ameliorated by such measures. Current research is focusing on the potential role of glutamine in slowing malabsorption and on combinations of diet and drug treatments. Asymptomatic patients are now the focus of concern. Preserving good nutritional status by attention to preventing weight loss and loss of lean body mass and assuring food safety are primary. Symptomatic patients require specific assistance depending on the presence of opportunistic infections and the drugs required. Specific nutrition support measures depend on whether or not the gut is functional.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nutrition support of HIV+ patients. 185 4

Investigators are now predicting that nearly 100% of the estimated 12 million HIV-positive persons in the world will develop AIDS. Most persons with AIDS will experience progressive weight loss and malnutrition prior to death. Because nutritional therapy clearly has a beneficial effect on the clinical course and immunologic status of the critically ill general population, one must not disregard its potential for benefits in the treatment of persons with AIDS. As a result of the escalating cost of medical therapy and the inevitable AIDS epidemic, the nutritional management of persons with AIDS must be simple to administer and cost effective. The author has developed nutritional screening criteria to identify those patients who would most benefit from nutritional therapy. Because these patients differ in their nutritional requirements, diet tolerance, and degree of gut dysfunction, there is no single nutritional therapy that can be used routinely to treat all malnourished persons with AIDS.
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PMID:Nutritional support of patients with AIDS. 190 49

In rural Haiti we measured and compared the muscle protein and calorie reserves (anthropometrics) as well as the visceral protein reserves (serum albumin, tuberculin sensitivity) in 56 HIV (human immunodeficiency virus type-1) seropositive and 108 HIV seronegative pulmonary tuberculosis patients. Results in patients were also compared to the results of the same measurements made in 160 age, sex and residence matched HIV seronegative controls without tuberculosis. Tuberculosis patients, regardless of HIV status, had significantly reduced muscle protein and calorie reserves compared to controls. The serum albumin was significantly lower in HIV seropositive tuberculosis patients (21.0 g/l) compared to HIV seronegative tuberculosis patients (26.9 g/l) and the serum albumin in both tuberculosis groups was significantly lower than in controls (41.3 g/l). The lower the serum albumin in the tuberculosis patients the greater the likelihood of a negative tuberculin test. HIV seropositive tuberculosis patients were significantly more likely to be tuberculin negative than HIV seronegative tuberculosis patients. Tuberculosis is associated with significant malnutrition. Worse malnutrition in tuberculosis patients co-infected with HIV suggests that the effect of the two pathogens on nutrition is additive or, alternatively, that tuberculosis patients who are particularly malnourished are at increased risk for HIV.
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PMID:Pulmonary tuberculosis, human immunodeficiency virus type-1 and malnutrition. 190 8


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