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Query: UMLS:C0019693 (HIV)
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The seroprevalence, clinical epidemiology, modes of transmission, clinical presentation in adults, pregnancy women and children, diagnosis, impact and control strategies of AIDS in Africa are covered in this review. HIV-1, the causative virus in AIDS, is epidemic in a central Africa belt from Gabon to the east coast, and from Uganda to Zimbabwe, with the highest prevalence in the lakes and highlands of Central Africa. HIV-2 causes a milder disease in Western Africa centered in Senegal. HIV infections occur primarily in young adult men aged 30-34, women aged 20-24, infants and children under 4, and a few girls. Transmission patterns vary widely depending on sexual customs in the ethnically diverse continent. Prevalence tends to be high in cities and among subgroups such as prostitutes, where promiscuity is restricted. Where female sexual permissiveness exists, seropositivity is high in women generally. Besides sexual behavior, risk factors for HIV in Africa also include uncircumcised man, oral contraception, STDs causing genital ulceration and Chlamydia infection. Transmission to neonates occurs, especially if the mother has advanced AIDS, but transmission by breast milk is uncertain. Transmission by blood transfusion is common because transfusion are up to 10 times as common in Africa as in the West, especially in obstetrics and pediatrics. Clinically, HIV infections present as herpes zoster in 95% of Africans, and commonly as slim disease: weakness, fever, chronic watery diarrhea and weight loss of unknown cause. Associated infection are candidiasis, cryptosporidiosis, isosporiasis, tuberculosis and salmonellosis. Other presenting symptoms are unusual sites of lymphadenopathy, cough and sepsis. Diagnosis can be made by the WHO clinical case definition, or be screening tests, which are now more reliable for African patients than formerly. In Africa, AIDS can cause destitution and disgrace for families, and will probable severely affect progress made national economies because of deaths of young productive adults. Strategies for control of HIV in Africa are outlined.
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PMID:AIDS in Africa. 218 39

The clinical manifestations of HIV infection in Africa are similar to those observed in Europe and North America. However, some features related to ecological and diagnostic factors give the disease a certain African peculiarity. In more than 80 p. 100 of the cases AIDS is characterized by deep alteration of the subject's general condition, with chronic diarrhoea, severe asthenia, prolonged fever and massive loss of weight. This "slim disease" is only found at the terminal stage of AIDS in North America. Opportunistic infections are multiple, often associated, and their frequency differs from that found in Europe and the USA. Thus, pulmonary pneumocystosis is rare (12.5 to 21 p. 100 of the cases, as against 50 to 80 p. 100 in Europe). Isosporosis is frequent (4 to 48 p. 100 of the cases instead of 0.2 p. 100 in the USA), and this also applies to cryptosporidiosis (7 to 21 p. 100 of the cases, compared with 3.3 p. 100 in the USA). Gastrointestinal candidiasis occurs in 21 to 49 p. 100 and cryptococcosis in 10 to 30 p. 100 of the patients. Material problems make it impossible to evaluate the prevalence of certain infections, notably toxoplasma and CMV infections. The prevalence of Kaposi's sarcoma is low (15 to 20 p. 100). Dermatological manifestations occur at an early stage and are both common and varied (papular eruption, prurigo, herpes zoster, changes in the hair and skin appearance); they characterize the "African aspect" of AIDS. Tuberculosis is particularly frequent: in Africa, 30 to 40 p. 100 of tuberculous patients are HIV seropositive, as opposed to 10-25 p. 10 in Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical aspects of AIDS in Africa]. 223 20

Etiologies of infectious diarrhoeas in hospitalised adults have been studied during one year; research of cryptosporidium and isospora oocysts is being made with Henriksen-Pohlenz and Kato methods. Diarrhoea is associated with a positive HIV serology in 40% cases. Cryptosporidium spp is found in 38% of cases. In 91% cases of cryptosporidiosis HIV serology is positive. Cryptosporidiosis is the main cause of AIDS diarrhoeas in Mali. 3 cases of isosporiasis are associated with cryptosporidiosis in AIDS patients. Emaciation and dehydration are the main signs of severity. Diarrhoea's profusion, its chronicity and inefficiency of the treatments explain the heavy death rate of cryptosporidiosis among seropositive patients, which reaches 40% during the first two weeks of hospitalisation.
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PMID:[Role of cryptosporidiosis in diarrhea among hospitalized adults in Bamako]. 228 1

Of about 40 patients with presumed enteropathic Acquired Immune Deficiency Syndrome (AIDS), i.e., oral thrush, diarrhea, and weight loss, admitted to Mulago Hospital medical wards, Uganda, from October through November 985, 23 patients were studied with upper gastrointestinal tract endoscopy and stool examination. Those patients chosen for study suffered with diarrhea, weight loss, and oral candidiasis and were willing to tolerate endoscopy. Weight loss was not quantified in most patients, but generally it was profound. 10 of the patients gave a history of genital sores or venereal disease. There were 16 males and 7 females with an age range of 19-47 years. All were sexually active, and all denied homosexuality anal intercourse, and intravenous drug abuse. 4 patients had had blood transfusion. The 23 patients represented a cross-section of the population with most social classes included. 20 patients were seropositive with antibody to HIV. Specimens from 2 patients were lost. 1 patient was seronegative. Apart from 5 patients who had been treated with nystatin for oral thrush and clinically presumed esophageal candidiasis, all the patients had oral thrush at the time of endoscopy. 20 patients had obvious esophageal candidiasis, and 1 patient had the appearance of Kaposi's sarcoma in the esophagus. Stool examination and histology of the upper GI tract showed that 11 patients had cryptosporidiosis and 3 had isosporiasis (total of 61% of patients with coccidian enteritis). 1 case of Mycobacterium avium mycobacteriosis also was identified. The incidence of cryptosporidiosis and isosporiasis is higher in Uganda than in developed countries.
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PMID:Enteropathic AIDS in Uganda. An endoscopic, histological and microbiological study. 312 96

We report on a 33-year-old male Turkish patient with primarily nonsuspect sexual behavior who presented with panuveitis unresponsive to therapy. HIV infection and secondary syphilis was diagnosed. The uveitis was the only manifestation of syphilis. Because of isosporiasis, an HIV infection of CDC class IV C1 was diagnosed. This is the second published case of acquired syphilitic uveitis in a patient with HIV infection. The diagnosis was delayed by a prozone phenomenon. Treatment with high doses of penicillin i.v. for 14 days led to complete recovery. Because the HIV infection may obscure the diagnosis of syphilis, this constellation will assume increasing importance with the growing number of HIV-infected patients.
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PMID:[Luetic uveitis in a patient with AIDS. Case report]. 320 24

In order to examine differences in the prevalence of AIDS-defining conditions by race/ethnicity, we analyzed U.S. surveillance data for 203,470 adolescents and adults diagnosed with AIDS from 1988 through 1992. A number of AIDS-indicator conditions were more common among certain racial/ethnic groups. The prevalence of extrapulmonary tuberculosis was higher among blacks, Hispanics, Asians/Pacific Islanders, and American Indians/Alaskan Natives than among whites. The prevalence of isosporiasis and toxoplasmosis was higher among Hispanics than among blacks or whites. Furthermore, the likelihood of being diagnosed with extrapulmonary tuberculosis (TB), toxoplasmosis, or isosporiasis was generally higher among foreign-born than among U.S.-born persons of all racial/ethnic groups. The prevalence of all malignancies was higher among whites than among blacks or Hispanics. However, the magnitude of prevalence differences by race/ethnicity was reduced when we controlled for other demographic and exposure risk categories. Although race/ethnicity was significantly associated with the prevalence of a number of conditions, the relative frequency and patterns of AIDS-indicator conditions in different populations are probably most influenced by differences in (1) underlying prevalence or exposure to various etiologic agents causing these conditions, (2) diagnosis and reporting of conditions, and (3) access to care and therapy for HIV-related conditions.
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PMID:How important is race/ethnicity as an indicator of risk for specific AIDS-defining conditions? 755

Four hundred and eighty six infected adults (90.7% men) were prospectively followed from 1988 to 1993 at a multiprofessional center in Santiago, Chile. 87.8% of male patients (pts)--84% of them homo/bisexual--and 64.4% of women acquired the infection sexually. At the beginning of the follow up (F/U) 51% of men and 71% of women were asymptomatic and 30% of the total group had AIDS. (AIDS definition: CDC 1993, excluded CD4 lymphocyte count < 200 x mm3). 240/486 (49.4%) had developed AIDS at the end of the study (12/31/93). AIDS defining events (ADE) were: interstitial pneumonia (confirmed or suggestive as caused by P. carinii [PCP]), 25%; tuberculosis (all forms), 22.1%; wasting, 13.8%; Kaposi Sarcoma, 9.2%; esophageal candidiasis, 6.7%; isosporiasis, 5.4%. Of all PCP cases, 72% were ADE, the rest, post.AIDS'. As expected, AIDS pts continued having major complications (mainly bacterial pneumonias, PCPs, esophagitis, tuberculosis and diarrhea due to I. belli and Cryptosporidium. Less frequently, but also observed, were toxoplasmic encephalitis and cryptococcal meningitis). Known mortality (excluded abandonment of F/U) was 27% for the whole group and varied from 5.8%, 51.6% to 69.2% for the first, 4th and 6th year of F/U respectively. For II-III CDC pts the mortality was 5% and 57% and for IV CDC pts it was 38% and 100% during the first and 6th year of F/U respectively. 36%, 53%, 74% and 85% of the pts followed for 1, 3, 5 and 6 years respectively had developed AIDS by the end of 1993. Multifactorial causes with either diarrhea, wasting or both were responsible for the death in half the pts in whom this was known, 15% died of respiratory complications and 5.7% of cryptococcal meningitis. 80% of AIDS pts survived their ADE. This study has provided information about the clinical profile of the HIV infection and natural history of the disease in Chile.
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PMID:[Clinical characteristics and natural history of human immunodeficiency virus infection. Study in a Chilean population served at a multiprofessional pilot center]. 756 47

To determine factors associated with isosporiasis in persons with acquired immunodeficiency syndrome (AIDS) in Los Angeles County, data from the AIDS surveillance registry were analyzed for the eight-year period 1985-1992. Isosporiasis was reported in 127 (1.0%) of 16,351 persons with AIDS during the study period. Prevalence of infection was highest among foreign-born patients (3.2%), especially those from El Salvador (7.4%) and Mexico (5.4%), and in all persons of Hispanic ethnicity (2.9%). Persons with a history of Pneumocystis carinii pneumonia (PCP) were less likely than PCP-negative patients to have isosporiasis (0.2% and 1.4%, respectively, P < 0.01). A decrease in the prevalence of isosporiasis in patients negative for PCP was observed beginning in 1989 (P = 0.02). Prevalence decreased with age (P < 0.01, by chi-square test for trend). After controlling for multiple factors by logistic regression, isosporiasis was more likely to occur in foreign-born patients than in those born in the United States (adjusted odds ratio [OR] = 5.8, 95% confidence interval [CI] 3.4, 9.9, P < 0.001) and in Hispanics than in whites (non-Hispanics) (adjusted OR = 3.5, 95% CI 1.7, 7.2, P < 0.001). A prior history of PCP continued to be negatively associated with isosporiasis (adjusted OR = 0.2, 95% CI 0.1, 0.3, P < 0.001). Age and time remained independently associated with infection. These data suggest that isosporiasis among persons with AIDS in Los Angeles County may be related to travel exposure and/or recent immigration and that the use of trimethoprim-sulfamethoxazole (TMP-SMX) for PCP may effectively prevent primary infection or expression of latent isosporiasis. Physicians should have an increased index of suspicion for Isospora in AIDS patients with diarrhea who have immigrated from or traveled to Latin America, among Hispanics born in the United States, in young adults, and in those not receiving PCP prophylaxis. Food and water precautions should be advised and TMP-SMX prophylaxis considered for the prevention of Isospora infection for patients with human immunodeficiency virus infection who travel to Latin America and other developing countries.
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PMID:Epidemiology of isosporiasis among persons with acquired immunodeficiency syndrome in Los Angeles County. 856 Dec 72

Worldwide, there are more than 18 million persons infected with HIV, the cause of AIDS. As HIV disease progresses, HIV-infected persons become vulnerable to various opportunistic infections that tend to vary from region to region. Tuberculosis is the most frequent serious opportunistic infection in sub-Saharan Africa. It is more prevalent in Latin America and in Asia than in the US. Bacterial and parasitic infections are common in sub-Saharan Africa. Toxoplasmosis, cryptosporidiosis, isosporiasis, and other fungal diseases are prevalent in Latin America. Fungal diseases, particularly cryptococcoses, and Penicillium marneffei infection, seem to also be prevalent in Asia. These regions have limited health resources. Regimens designed to prevent opportunistic infections that prolong and improve the quality of life of HIV-infected persons include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pneumococcal vaccine to Streptococcus pneumonia pneumonia. Scientists need to conduct research to identify the spectrum of opportunistic infections and the efficacy of different prevention measures in resource-poor countries. Health officials need to develop a minimum standard of care for HIV-infected patients. Since HIV/AIDS continues to grow in developing countries, scientists and health providers should pay as much attention to HIV/AIDS as to other tropical diseases.
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PMID:Preventing opportunistic infections in human immunodeficiency virus-infected persons: implications for the developing world. 870 12

Cryptosporidiosis and isosporiasis are intestinal infections caused by the protozoan parasites Cryptosporidium parvum and Isospora belli, respectively. HIV infection and other immunodeficiency diseases predispose human subjects to severe and prolonged cryptosporidiosis. There is also evidence that HIV infection predisposes to chronic isosporiasis. Strongyloidiasis is caused by a nematode worm, Strongyloides stercoralis. Administration of corticosteroids to patients with chronic low-grade S. stercoralis infection can trigger a fulminant, life-threatening form of strongyloidiasis.
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PMID:Parasitic diseases in immunocompromised hosts. Cryptosporidiosis, isosporiasis, and strongyloidiasis. 886 46


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