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

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

A 25-year-old man infected with the human immunodeficiency virus (HIV) presented with paroxysmal cough and dyspnea of 4-months duration. An extensive evaluation including bronchoscopy was negative. A nasopharyngeal swab was positive by direct fluorescent antigen detection and culture for Bordetella pertussis. Respiratory isolation, treatment with erythromycin, and prophylaxis of household contacts was used to eradicate the organism and prevent transmission. Pertussis should be considered as a cause of prolonged cough and dyspnea in patients with HIV infection. The course of this patient was consistent with the concept that cell-mediated immunity is necessary for elimination of B. pertussis.
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PMID:Pertussis in an adult man infected with the human immunodeficiency virus. 218 11

Children with human immunodeficiency virus (HIV) frequently have recurrent otitis media, chronic rhinorrhea, parotitis, cough and other common pediatric otolaryngologic problems. As these complaints often occur before more unusual opportunistic infections or pulmonary conditions prompt a diagnosis of acquired immunodeficiency syndrome (AIDS), members of our specialty are liable to see HIV-positive children before infection with the virus has been recognized. Children with HIV infection are also likely to be referred to us after diagnosis, as is any immunosuppressed child with otolaryngologic infections. These children may require procedures such as bronchoscopy, sinus irrigations or tympanocentesis. The subject of this review is the natural history of pediatric HIV infection with special emphasis on otolaryngologic manifestations and recommendations for safe techniques of examination and treatment.
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PMID:Pediatric human immunodeficiency virus infection: an otolaryngologist's perspective. 219 74

The clinical presentation of 60 consecutive Pneumocystis carinii pneumonias in 58 HIV-infected patients (48 men, 10 women, mean age 34 [22-53] years) was prospectively evaluated from April to August 1989 and compared with 60 consecutive P. carinii pneumonias in 59 HIV-infected patients (55 men, 4 women, mean age 37.5 [22-60] years) between 1981-88. Mortality rates within 14 days after diagnosis of P. carinii pneumonia were 50% (8 of 16 patients) until 1985, 20.5% (9 of 44) between 1986 and August 1988, and 1.7% (one of 60) in 1989. The degree of severity of the pneumonias at time of diagnosis was markedly lower in 1989, as shown by following parameters (averages of 1989, compared with averages of 1981-88): lactate dehydrogenase 540 (250-1419) U/l versus 680 (235-1920) U/l (not significant); alveolo-arterial difference of partial oxygen tension (pA-aO2) 22.9 (0.5-73.5) mmHg versus 39.7 (19-70) mmHg (P less than 0.001); score of radiological findings 1.4 (0-3) versus 2.7 (0-4) (P less than 0.001). In 1989, mainly clinical symptoms (dry cough: 57 of 60 cases, dyspnea: 44 of 60 cases, fever: 43 of 60 cases) initiated the diagnostic procedure: chest radiographs, lactate dehydrogenase and pA-aO2 were normal in 13, 25 and 33 episodes, respectively. The lower mortality rate of P. carinii pneumonia could not primarily be explained by therapeutical progress since the treatment of choice did not change fundamentally since 1981. Above all, early diagnosis fundamentally determined the probability of survival.
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PMID:[Pneumocystis carinii pneumonia in HIV infection: better prognosis because of early diagnosis]. 222 63

Pneumocystis carinii organisms cluster in alveolar casts. A method for concentrating alveolar casts in sputum specimens might improve the diagnostic usefulness of sputum studies in possible cases of pulmonary infection with Pneumocystis carinii. The use of sputum induction to detect Pneumocystis carinii was studied in 40 consecutive patients with known or suspected human immunodeficiency virus infection having bronchoscopy for evaluation of pulmonary disease. Sputum produced by deep coughing induced by 3% saline via a jet nebulizer was liquefied with dithiothreitol, and cells were sedimented and stained. Liquefaction of mucus allowed concentration of alveolar casts where P. carinii cysts were readily identified. A total of 28 patients were found to have P. carinii, which was detected in concentrated sputum in 21 of 38 patients, unconcentrated sputum in 10 of 38 patients, and by bronchoscopy in 25 of 37 patients. Sensitivity of concentrated sputum compared with bronchoscopy was 78% (95% CI, 58 to 90), with a negative predictive value of 71% (95% CI, 47 to 87). Values for unconcentrated sputum were 43% (95% CI, 25 to 63) and 48% (95% CI, 30 to 67), respectively. Liquefaction of adequately induced sputum facilitates processing and interpretation and increases yield for P. carinii, eliminating the need for invasive procedures in most patients.
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PMID:Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum. 245 45

Inpatient and community-based care can be complementary in relation to the management of HIV disease. Medical records from 200 inpatients of Chikankata Hospital near Lusaka, Zambia and 200 home based patients were examined and compared for the common symptoms of presentation of HIV disease, associated opportunistic infections, and treatment protocols. Drug costs of both groups were also compared. The most common respiratory symptoms in the 2 groups are cough, chest pains, weight loss, and hemoptysis. Treatment employed for these symptoms were cortimoxazole, penicillin V, erthromycin, and tetracycline. Acetyl saliclic acid and paracetamol were used for pain relief in both groups. Gastointestinal system symptoms for both groups were diarrhea, weight loss, abdominal pain, and vomiting. Cotrimoxazole and metronidazole were used in treating diarrhea. Additional treatment protocol for the 2 patient samples included oral rehydration therapy for dehydration, antacid or bismuth subsalicylate for diarrhea and enteritis, and mycostatin for oral candidiasis. Central nervous system symptomatology included headache, dementia, neckace, and lethargy. Chloramphenicol was employed in treating bacterial meningitis. Diazepam and chlorpromazine were effective for restless patients. Genito-urinary system symptomatology for the 2 groups included dysuria, genital ulcers, hematuria, viral warts, and buboes. Antibodies were used for sexually transmitted diseases and infections. Skin symptomatology included rash and dermatitis, herpes zoster, abscess, kaposi's sarcoma, ulcers, furunculosis, and discharging anal sinus. In treating these symptoms, hospital based care and home based care were similar. Overall, it was found that hospital treatment protocols were detailed, expensive, and time consuming. Furthermore, hospital treatment for HIV positive patients is more expensive than HIV negative patients; hospital costs for 50 HIV negative patients totaled US$415.94 compared to US$1204.98 HIV positive/PTB negative patients and US$1705.62 for HIV positive/PTB positive patients. Drug cost/patient admission is increased by 469% if HIV positive. (author's modified).
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PMID:Clinical care as part of integrated AIDS management in a Zambian rural community. 248 94

Whereas extralymphatic involvement is common in lymphomas associated with HIV infection, there have been few reports of pulmonary lymphoma. In 648 cases of AIDS reported in Colorado, 40 have had non-Hodgkin's lymphoma. Of these, four have had documented pulmonary involvement and are reported in detail. Clinical manifestations were nonspecific and included fever, weight loss, generalized lymphadenopathy, dyspnea, chest pain and cough. Chest roentgenograms revealed multiple nodules or interstitial infiltrates. Transbronchial biopsy failed to establish the diagnosis in all cases. Three of four patients died four to five months after appearance of pulmonary nodules; one patient with stage IE disease showed slow radiographic progression over 16 months following radiation and chemotherapy and died 18 months after appearance of pulmonary nodules. Pulmonary involvement with lymphoma should be considered in patients with HIV infection, especially if multiple nodules are seen on chest roentgenograms.
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PMID:Pulmonary non-Hodgkin's lymphoma in AIDS. 258 39

This study surveyed 975 undergraduates attending a large East Coast university during the spring semester of the 1987/88 academic year. A convenience sample of predominantly black students (94%) participated. Overall, knowledge of basic AIDS-related facts was satisfactory. Raw scores on the 25-item knowledge scale ranged from 7 to 25, with a mean of 20.5 (82%) and a mode of 22 (88%). Selected questions on how HIV is not transmitted, however, posed some problems for respondents. Less than 30% of respondents knew that the AIDs virus was not transmitted by insects; less than 80% knew that AIDS was not transmitted on toilet seats, through blood donations, kissing, and coughing. The survey also asked students whether they had ever engaged in certain behaviors that put them at risk of HIV infection. Approximately 17% of respondents had experienced anal intercourse, 6.5% reported use of heroin, 32.6% reported having had multiple sex partners, and 16% had been treated for a sexually transmitted disease. Students who reported engaging in high-risk behaviors had statistically significant lower mean knowledge scores than those who reported not engaging in those same high-risk behaviors. Results of the study support the need to increase efforts to deliver AIDS information specifically targeted to individuals who may be engaged in high-risk behaviors. Special health education programs must be designed to focus attention on risk behaviors (ie, unprotected anal intercourse) instead of risk groups (ie, homosexual and bisexual males).
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PMID:Knowledge about AIDS and reported risk behaviors among black college students. 277 26

AIDS and tuberculosis (TB) are both endemic in Bujumbura, Burundi. An 11% failure rate to standard antituberculosis treatment (n = 173) was observed at the Tuberculosis Treatment Center of Bujumbura (CATB) in 1985-1986. All resistant cases (n = 19) were HIV seropositive. Among 328 consecutive cases with tuberculosis at the CATB during a 3 month period in 1986, 54.5% were HIV seropositive, which is five times higher than the prevalence in the general population in Bujumbura. More female patients than male cases were HIV antibody positive (62 versus 49%, respectively; p less than 0.02). Persistent weight loss, cough, and an anergic tuberculin test were more common in the HIV-seropositive group. Among 48 household members of HIV-seropositive patients with tuberculosis, 6 (12.5%) new cases of tuberculosis were identified, compared with none among 28 household members of HIV-seronegative patients with tuberculosis (odds ratio, 3.8; 95% confidence interval, 0.43-33.2). HIV infection is a new risk factor for tuberculosis in Africa, and HIV-infected cases of tuberculosis may be more infectious than HIV-negative patients. The AIDS epidemic may drastically complicate the diagnosis, management, and control of tuberculosis in populations in which both infections are endemic.
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PMID:The association of tuberculosis and HIV infection in Burundi. 278 94

Three independent cross-sectional surveys of public knowledge and attitudes about AIDS were conducted on a representative sample of people aged 15-54 resident in Wales. 1,303 were interviewed in their homes in February 1987, 683 in September 1987 and 676 in March 1988. The results show that most people knew that having sexual intercourse or sharing needles with people with AIDS represented a high risk of catching AIDS. However there appeared to be considerable misunderstanding about the nature of HIV infection such that one in three thought that a man and woman with a single heterosexual partner was at high or moderate risk of catching AIDS. The high level of concern coupled with considerable confusion appears to have contributed to both unnecessary anxiety and prejudice. One in four people thought that kissing or being spat on by a person with AIDS represented a high or moderate risk, and one in six thought that coughing, sneezing and sharing towels, soap, drinking utensils or lavatory seats were routes of transmission. More than 50% of men and 40% of women said that it was their own fault if homosexuals and drug addicts got AIDS and did not feel sorry for them. It is concluded that action to date to limit the spread of AIDS has informed but not yet adequately educated the public. If unwanted anxieties and prejudice are to be diminished, initiatives by government, health services and others must now concentrate on developing understanding about the nature of HIV infection and its spread through more personal education.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Public knowledge and attitudes to AIDS. 278 32


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