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In 1985, at a WHO workshop on AIDS in Bangui, Central African Republic, a clinical case definition of AIDS was developed for developing countries. This 1st definition contained 4 major criteria (chronic asthenia, major weight loss, chronic fever, and chronic diarrhea) and 6 minor criteria (chronic cough, persistent lymphadenopathy, herpes zoster, recurrent herpetic infection, pruritic dermatitis, and oropharyngeal candidiasis). Kaposi's sarcoma and cryptococcal meningitis were sufficient by themselves for the diagnosis of AIDS. In children, the temporary definition of AIDS consisted of 3 major clinical criteria (weight loss and/or abnormally slow growth, chronic diarrhea lasting more than 1 month, and fever lasting more than 1 month), and 6 secondary clinical criteria (generalized lymphadenopathy, oropharyngeal candidiasis, repeated common infections such as otitis and pharyngitis, persistent cough, generalized pruritic dermatitis, and confirmed maternal HIV infection). The revised Bangui definition was evaluated in 174 adult patients hospitalized at the Mama Yemo Hospital of Kinshasa, Zaire. 46% of 174 patients met the criteria of the WHO/Bangui definition. Overall, the sensitivity of the definition for HIV-1 infection was 59%, the specificity was 90%, and the positive predictive value (PPV) was 74%. However, the clinical case definition of African AIDS lacks specificity when it is applied to patients suffering from cachectic syndromes. The Bangui definition was also evaluated at the pediatric ward of Mama Yemo Hospital with 159 hospitalized children whose mean age was 33 months. 21 (13%) were infected by HIV-1. The sensitivity of the definition was 35%, its specificity was 86%, and its PPV was 26%. Although the specificity was relatively high, the low values of sensitivity and PPV underline the weakness of the Bangui clinical case definition for diagnosing pediatric AIDS cases.
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PMID:World Health Organization clinical case definition for AIDS in Africa: an analysis of evaluations. 133 10

In the early 1990s, HIV seroprevalence in the rural community in Casamance, Senegal was .8% (age range from 24 to 68 years). 25 people had HIV-2 infection and 2 had HIV-1 infection. Health workers evaluated 22 of the HIV-2 positive adults and compared them with 64 matched controls. The HIV-2 positive adults were 7.25 times more likely to suffer from ill health than the controls (50% vs. 12.5%). Clinical signs of HIV-2 positive status were more common among HIV-2 positive adults than controls (40.9% vs. 7.8%; odds ration [OR] = 8.2), especially chronic cough (OR - 18.5). Presence of diarrhea was insignificant (22% vs. 40%). HIV-2 positive adults had much higher levels of CD8 cells (p = .03), IgG (p = .0001), and beta 2 macroglobulin (p =.001) than the controls. Their CD4/CD8 ratio levels were much lower than those of the HIV-2 negative individuals (1.1 vs. 1.9; p = .0001). Among HIV-2 positive adults, symptomatic adults had significantly lower levels of red blood cells (p = .02), white blood cells (p = .02), lymphocytes (p = .01), T cells (p = .01), and CD4 cells (p = .002) than the healthy adults. Their beta 2 macroglobulin levels were much greater than controls (4.6 mg/vs. 2.9 mg/l, p = .03). 5 HIV-2 cases (22.7%) researchers suffered from immunosuppression (500 CD4 cells/mcl) compared with only 1 control (1.6%) (OR = 18.5). Clinical symptoms were more likely to be present in immunodepressed people than in non immunodepressed people (35.7% of 14 sick adults vs. 1.4% of healthy adults). 1 person who had AIDS as defined by WHO (weight loss, persistent cough, and diarrhea) had 429 CD4 cells/mcl. 1 person suffered from bronchopneumonia (326 CD4 cells/mcl). Another person had chronic diarrhea and bronchopneumonia (350 CD4 cells/mcl). The mean age of HIV-2 infected people who had a respiratory condition was 51 years (42-68 years) while it was 41 years (26-68 years) for asymptomatic HIV-2 infected people indicating a rather long incubation period. These results suggested that HIV-2 can be significant public health problems.
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PMID:HIV-2 infections in a rural Senegalese community. 140 31

In 1990, among pregnant women .1% tested positive for HIV antibodies in Amsterdam compared to 24.5% in Lusaka, Zambia. During 1990 and 1991 data were collected from 231 patients fulfilling the WHO clinical criteria for the diagnosis of AIDS in 3 hospitals of Sesheke, a rural Zambian district. 46.3% of the group was male and 53.7% was female, and the mean age of women was significantly lower than that of men (25.2 vs. 31.1 years, p 0.001). A total of 185 patients could be tested for HIV-1 antibodies using ELISA-Welcozyme and HIVCECK-Du Pont. There were 141 (81.6%) positive results, 19 (10.3%) negative results, and in 15 (8.1%) cases the outcome was not clear. Seroprevalence figures for HIV-1 in the same period were 16% for blood donors and 41% for patients attending the clinic for sexually transmitted diseases. Most patients with AIDS in Sesheke district present with a wasting syndrome, and in these cases, tuberculosis (TB), whose incidence has increased dramatically, has to be excluded. Loss of more than 10% of body weight was the most common symptom followed by chronic cough lasting for more than 1 month, fever persisting for more than 1 month, and chronic diarrhea lasting for more than 1 more. Chronic coughing was more frequent among adults than among children (P 0.001). Weight loss, chronic diarrhea, persistent coughing, generalized lymphadenopathy, generalized dermatitis, and oropharyngeal candidiasis occurred among both adults and children equally often. Only 4 patients (18%) and extrapulmonary TB in 10 patients (4%). In the district there was no registration system for the dead and the follow-up of AIDS patients were not organized well, but as of January 1, 1992, from hospital records it was established that 74 patients out of the 231 studied were decreased. The outlook for the population in Sesheke and Zambia is dim in light of the current high seroprevalence rate.
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PMID:[AIDS in a Zambian district]. 147 Feb 44

Sixteen human immunodeficiency virus type 1 (HIV-1)-seropositive children aged 5 to 12 years (nine girls and seven boys), born to HIV-1-infected mothers, were diagnosed between 1984 and 1987 in Kigali, Rwanda. They were compared with a group of age- and sex-matched HIV-1-seronegative children consecutively selected from the outpatient department. Two subjects were asymptomatic. Chronic cough was the most frequent symptom (seven of 16 patients). The most common signs were short stature (12 of 16 patients), low weight for age (seven of 16 patients), chronic parotitis (eight of 16 patients), persistent generalized lymphadenopathy (seven of 16 patients), and pulmonary tuberculosis (four of 16 patients). Lymphoid interstitial pneumonitis was diagnosed on radiologic grounds in five of 16 patients. Evidence of perivasculitis in the fundus was noted in three of 16 patients. Two children died during the study period (mean duration of follow-up, 40 months; range, 27 to 62 months); none of the other children had life-threatening infection or loss of developmental milestones. Immunologic assessment in the 16 children revealed high levels of IgG, decreased CD4+/CD8+ ratio, and skin test anergy. Endocrinologic investigations revealed normal thyroid function and normal basal human growth hormone levels but low basal insulinlike growth factor I levels (0.21 +/- 0.07 vs 0.44 +/- 0.20 U/mL for controls). In Kigali, perinatally HIV-1-infected children surviving beyond 5 years of age often present with moderate signs and symptoms, principally pulmonary involvement, chronic parotitis, and persistent generalized lymphadenopathy. Short stature is the major clinical manifestation in these patients and may be due, in part, to low growth hormone secretion rather than to malnutrition.
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PMID:Clinical and endocrinologic manifestations in perinatally human immunodeficiency virus type 1--Infected children aged 5 years or older. 195 Dec 15

We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period.
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PMID:Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda. 205 69

Nine black children aged between 3 months and 30 months of age, with human immunodeficiency virus type I (HIV-I) infection are described to draw the attention of health professionals in southern Africa to special clinical characteristics useful for recognising this problem, which has many shared features with common diseases of infancy and childhood in the Third World. The main presenting complaints were chronic cough and persistent diarrhoea and vomiting. These children frequently had diarrhoea (8 of 9 patients), mucocutaneous candidiasis (8), pneumonia (7), hepatosplenomegaly (9), significant lymphadenopathy (5) and wasting (5). All were infected by common bacteria, such as Gram-negative organisms, Mycobacterium tuberculosis and Campylobacter jejuni, or by opportunistic infections such as Candida or cytomegalovirus (CMV), or by both bacterial and opportunistic organisms. A raised total serum globulin level, anaemia, lymphopenia and a cerebrospinal fluid (CSF) pleocytosis were frequent findings. Incomplete data on parental HIV status suggest perinatal transmission. Three of the children were HIV-antigen positive. The diagnosis of full-blown acquired immunodeficiency syndrome (AIDS), using the stringent Centers for Disease Control criteria, is difficult in our situation because of limited diagnostic resources; however, using these criteria, and the clinical case definition for AIDS recommended by World Health Organisation, it is thought that probably 4 of these children could be considered as having AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Some early observations on HIV infection in children at King Edward VIII Hospital, Durban. 223 85

The predominantly heterosexual transmission of human immunodeficiency virus (HIV) in Africa suggests that pediatric acquired immunodeficiency syndrome (AIDS) could develop into a significant child health problem in this region. To assist clinicians in recognizing HIV infection in African children, the clinical features of 185 children with symptomatic HIV-related disease diagnosed at the 2 central hospitals in Harare, Zimbabwe, from April 1986-July 1987 were enumerated. In this period, 185 such cases were diagnosed. 83 (47%) involved children 0-12 months of age and another 61 (35%) represented children 13-24 months old. The male/female ratio was 1.0:1.03. The most frequently recorded clinical feature (52% of cases) was generalized lymphadenopathy, with or without hepatosplenomegaly. 45% of HIV-infected children presented with respiratory symptoms and pulmonary infiltrates on chest x-ray. Failure to thrive was present in 38% of cases. Also relatively common were hepatomegaly and splenomegaly (35% and 26%, respectively). Chronic, recurrent diarrhea was present in 21%. Less frequently observed (under 10% of cases) clinical findings were maculopapular eczematoid rashes, parotid swelling, chronic suppurative otitis media, chronic mucopurulent rhinitis, meningitis, and encephalopathy. 3 main clinical modes of presentation were identified--children with failure to thrive or marasmus in association with chronic diarrhea and developmental delay, those with generalized lymphadenopathy and hepatosplenomegaly, and children who present with chronic cough with pulmonary infiltrates on chest x-ray.
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PMID:Clinical presentation of symptomatic human immuno-deficiency virus in children. 226 23

A relation between tuberculosis (TB) and HIV infection is well established. 20-60% of AIDS patients in developing countries have been found to have or to develop TB. The combined effects of HIV and TB epidemics on the health systems of developing countries is frightening. To check the growing numbers of HIV-associated TB cases, the US Centers for Disease Control and Prevention and the World Health Organization recommended TB skin testing of HIV-positive people. Those found to be dually infected would be offered prophylactic isoniazid. Most developing countries, however, cannot afford such preventive therapy. The authors investigated whether screening for TB infection and disease at HIV-testing sites is an useful approach to TB control in developing countries. The authors offered skin testing and a brief clinical exam for active TB to people requesting HIV testing at one center in Santo Domingo, Dominican Republic. 200 newly detected HIV-positive individuals were subsequently compared against 200 age and sex-matched HIV-negative individuals. 9.7% of the people seeking HIV testing had active TB; 29 were HIV-positive and 10 HIV-negative. Multivariate analysis found the strongest independent predictors of active TB to be 10 mm or more of induration on skin testing, an history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. These findings lead the authors to conclude that screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among both HIV-seropositive and HIV-seronegative people. Integrating screening for TB into HIV testing schemes could help reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.
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PMID:Screening for active tuberculosis in HIV testing centre. 770 5

In Zambia, 10-15% of urban adults are reported HIV positive, as are over 80% of prostitutes. The HIV seroprevalence rate in a Lusaka hospital's intensive care unit was 21% (27% for surgical and 18% for trauma admissions). HIV-infected patients could be clinically recognized by risk factors or symptoms and signs: weight loss, chronic cough, chronic diarrhea, sepsis, septic arthritis, subacute hematogenous osteomyelitis, a history of sexually transmitted diseases (STDs), death of a spouse or of a child under age 2, recent pregnancy unable to go to term, poor quality or thin hair, appearance of aging beyond years, mental slowness, persistent or unexplained fever, lymphadenopathy, aggressive atypical Kaposi's sarcoma, oral thrush, hairy leukoplakia of the tongue, shingles scars, and scars of maculopapular dermatitis. Common sites for HIV-related sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (e.g., necrotizing fascitis), and bone and joints. Autologous blood transfusion and use of donor blood screened for HIV antibodies, preferably limited to emergencies, would reduce the likelihood of iatrogenic HIV transmission. Surgeons should wear two pairs of gloves, a waterproof gown, and goggles to protect themselves from HIV transmission. If they have skin rashes, cuts, or abrasions on the hands or arms, they should not perform operations. Proper cleaning and disinfection of endoscopes are required. The risk of infection from a needle stick is small ( 0.4%).
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PMID:Surgery, surgical pathology and HIV infection: lessons learned in Zambia. 786 25

This study was performed in the Sereer region 150 km to the east of Dakar, the capital of Senegal. The population of the region is characterised by large seasonal migration, a high divorce rate (41% of marriages end in divorce) and frequent polygamy (1.8 married women per married man). We organised the medical centres in the region to monitor actively the epidemiology of HIV infection. Three populations were targeted: pregnant women presenting for their first prenatal consultation; patients presenting with STD; and people with chronic (more than three weeks) cough. The patients consulting for STD were recruited two ways: those presenting spontaneously and those identified during home interviews by the team performing a parallel sociological study of behaviour. Overall, the prevalence of HIV seropositivity was 0.2% of the women and 1.3% of the men (the difference is not significant). The seropositive individuals identified were 2 pregnant women and 5 patients (3 of 409 women and 2 of 84 men) with STD. There was no significant difference between the sex, age, marital status, or type of recruitment (spontaneous or identified by the sociological survey) of the HIV seropositive and seronegative individuals. The prevalence of treponema antibodies was 1.8% among pregnant women, 2% among STD patients and 2.4% among patients with chronic cough. There was no significant difference according to age, sex, marital status or motivation for consultation. More than half the patients consulting for STD presented biomedical disease. The majority of the STD patients were women: 70% of those spontaneous consulting; 90% of those identified by the survey; and 92% of those with biomedical disease were women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of the risks of sexually transmitted diseases and HIV infection in a rural region of Senegal in 1991]. 789 29


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