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Query: UMLS:C0019693 (HIV)
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In 1987, data from the Centers for Disease Control AIDS data base indicated a 50% prevalence of oropharyngeal Candida infection, a 10% rate of esophageal infection, and .5% rate of bronchopulmonary infection among AIDS patients. Candida-positive blood cultures were found in 13 of 903 AIDS patients, and disseminated Candida infection was ascertained in 11 of 101 post mortem examinations of AIDS victims. 5 of 12 patients with oral Candida infection progressed to AIDS within a 42-week investigation as opposed to only 1 of 17 patients without Candida. In the former group, CD4 counts and CD4/CD8 ratios were also significantly lower. Most infections were caused by Candida albicans. Genital Candida occurs in 5-20% of women in reproductive age. In a study of 66 HIV-infected women Candida vaginitis preceded oral Candida infections which preceded Candida esophagitis. 33 women had vaginal infection, 25 had oral Candida, and 9 had esophageal infection with reduced CD4 counts. Infections of the oropharynx and the vagina are reduced CD4 counts. Infections of the oropharynx and the vagina are treated with amphotericin B, nystatin, miconazole, and clotrimazole. Systemically effective compounds include ketoconazole, itraconazole, and fluconazole, although interactions with rifampicin, phenobarbital, and phenytoin used in HIV treatment occur. Fluconazole is contraindicated in C. glabrata and C. krusei infections as it selects for azole-resistant Candida strains. Iv amphotericin B and fluconazole are used in serious infections when oral treatment is ineffective.
Int J STD AIDS
PMID:Candida infections in AIDS patients. 161 60

Chronically immunosuppressed individuals are susceptible to lymphoreticular tumors. Up to 15% of patients with congenital deficiencies such as ataxia=telangiectasia may develop malignancies, mainly high-grade B cell non=Hodgkin's lymphomas (NHLs). AIDS lymphomas are comprised of NHLs including Burkitt's lymphoma (BL) and primary cerebral lymphomas (PCLs). Almost 3% of all AIDS patients (2824 of 97,258 cases) developed NHL. Epstein-Barr virus (EBV) as a co-factor in AIDS lymphomagenesis has been studied: in 12 cases of 24 AIDS lymphomas EBV by DNA in situ hybridization was found. In an analysis of 6 primary cerebral lymphomas, .5 were positive for EBV DNA by Southern blotting. In Burkitt's lymphoma the characteristic genetic alteration affects the c-myc oncogene. In 1/3 of BL p53 mutations were found but none in the 43 NHLs suggesting that p53 mutations and c-myc activation act synergistically in the pathogenesis of these tumors. Cytotoxic agents dideoxyinosine, dideoxycytosine, and zidovudine may cause secondary neoplasia. 8 of 55 AIDS patients under zidovudine treatment developed high-grade lymphoma 23.8 months subsequently; recently doses were reduced. PCL was found in 21 of 90 patients. A 5.2 months survival was associated with combined treatment with cyclophosphamide, Oncovin (vincristine), methotrexate, etoposide, and cytosine arabinoside compared with 11.3 months with chemotherapy. Colony-stimulating factors (CSFs) alleviate drug-induced myelotoxicity and zidovudine-induced neutropenia, however, l8 of 11 patients receiving granulocyte-macrophage CSF developed hematological toxicity. Interleukine-2 produced by T-helper cells enhancing tumor cells cytotoxicity has been used in AIDS-associated cryptosporidial diarrhea and in 4 patients with AIDS lymphoma with modest response, but its stimulation of the HIV-infected substrate may increase viral proliferation.
Int J STD AIDS
PMID:AIDS lymphomas. 161 63

Much remains to be learned about the microbiological dynamics of male to female heterosexual HIV transmission. Research has yet to determine whether infections results from female exposure to free virus in semen, HIV-infected white cells, or both. Once in the woman's reproductive tract, does HIV penetrate cervical mucus or vaginal epithelium, transverse a cervical ectopy, or enter the bloodstream at some alternative site. Empirical evidence does support the existence of differing degrees of individual HIV infectiousness and susceptibility. Male to female transmission is thought to be more efficient than vice versa, and infection with another STD is an important independent factor contributing to susceptibility to HIV. Given the difficulty of obtaining clinical data on these questions, it is difficult to advise people on their contraceptive options. This quandary rings especially true when one considers that some contraceptives may reduce the risk of HIV infection, while others may help facilitate its entry. With these concerns in mind, the authors discuss available information on chemical and mechanical barrier methods, natural methods such as breast feeding, ovulation prediction, and coitus interruptus, as well as methods under development. Prevention strategies are discussed in a closing section.
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PMID:Contraception and safer sex. 163 58

In order to obtain more information on sexual transmission of hepatitis C (HCV) we compared different high-risk groups for HIV and hepatitis B to see if they were seropositive for HCV. A high seroprevalence (38/81) of hepatitis C (HCV) was found among intravenous drug users. Nursing staff (n = 35) and patients of a dialysis unit (n = 57) had a low prevalence of anti-HCV antibodies (0% and 5%, respectively). Serology laboratory technicians also had a very low prevalence (0% out of 29). Among prostitutes (n = 114), healthy homosexual men (n = 132) and HIV-infected homosexual men (n = 31), we found a remarkably low seroprevalence of HCV (3.5%, 0.8% and 0.0% respectively). These data support the view that parenteral exposure to the virus is the most important way of acquiring the infection and that neither heterosexual nor homosexual promiscuity are associated with a high risk of transmission of hepatitis C.
Int J STD AIDS
PMID:Hepatitis C among risk groups for HIV and hepatitis B. 165 May 87

In Africa, HIV transmission occurs mainly through heterosexual intercourse. High-frequency transmitter core groups are key to the epidemiology of HIV-1 and STD on the continent. The rapid growth of the HIV-1 epidemic in Africa appears to have resulted, in part, from social and economic factors which result in individuals' frequent engagement in sexual intercourse with members of HIV-infected core groups. Understanding the importance of core groups in HIV-1 transmission is therefore key to developing more effective programs for the control of HIV-1. Sections explore the core groups concept and the sexual transmission of infection, social and economic forces creating core groups in Africa, the interaction of STD and HIV-1 in core groups, the effect of STD on HIV-1 disease progression in core groups in accelerating the HIV-1 epidemic, the role of core group interventions in control programs, balancing disease control with the potential for victimization, and research needs.
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PMID:The importance of core groups in the epidemiology and control of HIV-1 infection. 166 15

Determination of the prevalence and incidence of HIV infection is essential in monitoring the scope of the HIV pandemic. During the late 1980s, HIV seroprevalence studies and surveys were conducted in most countries in Africa. Despite some problems, seroprevalence studies in many African countries continue to be important advocacy tools for securing or increasing support for HIV/AIDS prevention activities and contribute toward understanding the spread of the pandemic. There have been few studies to determine the incidence of HIV infection in Africa, mainly because of the lack of well-established cohorts, although data on incidence have recently become available. This paper reviews HIV seroprevalence and incidence reports from Africa, published or presented at scientific conferences in 1990, and provides a discussion on the interpretation and use of the data. The prevalence of HIV antibody in Africa is discussed among general population groups, convenience samples of selected groups of individuals, pregnant women attending antenatal clinics, female prostitutes, STD clinic attenders, and hospital patients.
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PMID:Prevalence and incidence of HIV infection in Africa: a review of data published in 1990. 166 27

We enrolled 253 HIV-antibody positive heroin addicts without HIV-related disease (n = 81) or with persistent generalized lymphadenopathy (n = 172) in a prospective study to evaluate clinical progression to AIDS related complex (ARC) or AIDS and to identify factors of possible prognostic relevance. Follow-up lasted between 6 and 40 months (median 12 months). According to the non-parametric Cox's model the only significant (P less than 0.001) prognostic variable was T4+ cell count considered in three classes: greater than 800/microliters (no depletion), 400-800/microliters (moderate depletion) and less than 400/microliters (absolute depletion). Subjects with T4+ cell count of less than 400/microliters had a risk of developing ARC or AIDS that was 6.46 and 1.98 higher than those with values of greater than 800/microliters or between 400 and 800/microliters respectively. The estimated probability of progression to ARC or AIDS was 0.029, 0.056 and 0.172 at one year in subjects with T4+ cell count of greater than 800/microliters 400-800/microliters and less than 400/microliters, respectively, and 0.296, 0.501, and 0.896 at two years.
Int J STD AIDS
PMID:T4+ cell depletion as a major risk factor for AIDS-related complex and AIDS. Longitudinal study of 253 HIV-antibody positive heroin addicts from northern Italy. 167 62

The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was conducted (n = 961). Thirty-seven percent of physicians reported regularly asking new adult patients about their sexual practices; 60% asked new adolescent patients. STD/HIV risk questioning was associated with physicians' confidence in their ability to help prevent HIV, comfort with discussing patients' sexual practices, and perception of a large STD/HIV problem in their practice. These findings suggest that continuing medical education should target improvement in physicians' sexual practice questioning skills.
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PMID:Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area. 174 64

140 consecutive African, exclusively heterosexual, adult outpatients to the Clinique des Maladies Sexuellement Transmissibles, with genital ulcers or urethritis, were studied in order to determine the status for HIV1-infection and syphilis. Comparison with 194 age and sex matched subjects, without STD, were chosen as controls. In the "STD"'s population, the HIV1 seroprevalence was 17.8%, and anti-treponema antibodies were found in 30% of the cases. Patients with genital ulcer were associated with a higher HIV1 seroprevalence than patients with urethritis. The "STD"'s population in Bangui is at risk for HIV1-infection (risk ratio: 2.12), and constitutes probably a very sensitive group in Central Africa for the epidemiological survey to HIV infection, and for the estimation of the prevention against AIDS.
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PMID:[Seroprevalence of HIV-1 infections in patients consulting the clinic for sexually transmitted diseases in Bangui, Central African Republic]. 176 52

For over a year, the Tacoma Syringe Exchange has been operating in spite of existing drug paraphernalia laws. One hundred fifty-four subjects have been interviewed regarding drug injection practices for the month prior to first use of the exchange and for the most recent month since using the exchange. Statistically significant reductions in mean frequency of obtaining used syringes, and in mean rate of passing on used syringes, have been reported. Mean number of times bleach was used to disinfect contaminated syringes has risen. The exchange continues to attract mainly men, median age 35, with a long history of injection. No differences have been observed in mean number of injections per month. In order to increase utilization, new sites are planned, but expansion has been hampered by a series of legal problems. Since the exchange draws many difficult to reach individuals, it is an important location for STD screening and drug treatment recruitment. Documentation of participation patterns and barriers to exchange use, and effects upon HIV serological status are recommended.
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PMID:The Tacoma Syringe Exchange. 177 1


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