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 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This review describes the transmission, clinical picture and immunological abnormalities of HIV infection in children in general, and the special problems of AIDS in African children. The review begins with a thorough introduction to the epidemiology of AIDS. Transmission to children generally involves vertical transmission by placental transfer or transmission of HIV via transfusion of blood and blood products, or by contaminated needles. Casual transfer is unknown, and only a few cases of transmission via breast milk are known. The clinical picture of HIV infection in infants and children differs from that in adults in 3 important aspects: earlier onset, different clinical presentation and existence of AIDS embryopathy. The average onset was 5 months of age. The most common symptoms in young children are chronic interstitial pneumonitis without demonstrable etiology, hepatomegaly, failure to thrive, adenopathy, diarrhea, oral or perineal thrush, eczema and thrombocytopenia. The common opportunistic infections are pneumocystis carinii pneumonia, cytomegalovirus, Epstein-Barr virus, Cryptosporidium diarrhea, pyogenic infections of the middle ear and gram-negative septicemia. Several infections seen in adult AIDS cases are rare in children: mycobacterium avium-intracellulare, toxoplasma gondii, hepatitis B, as well as Kaposi's sarcoma, malignant lymphoma and cardiac abnormalities. The AIDS embryopathy or HIV dysmorphic syndrome is characterized by immunological abnormalities, growth failure, and craniofacial dysmorphism, particularly microcephaly, prominent box-like forehead, hypertelorism, flattened nasal bridge, obliquity of the eyes, blue sclerae and patulous lips. AIDS in African children is extremely difficult to diagnose because of similarities between the presenting symptoms and those commonly seen in sick children there, many of whom are also immune compromised. Where serotesting is available, the picture is complicated by cross reaction between the test agents and some factor found in sera from malaria patients. Seropositivity in some areas is high, increased by the prevalence of transfusion and injection treatments. Diagnosis is made more difficult by lack of laboratory facilities and difficulties in follow-up for pediatric patients. The CDC definitions of AIDS and ARC, and the WHO/CDC definitions of AIDS are appended.
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PMID:Human immunodeficiency virus infection in childhood. 245 15

This study represented the 1st attempt to isolate human immunodeficiency virus (HIV) from African acquired immunodeficiency syndrome (AIDS) patients and controls. HIV was isolated from 27 (77%) of 35 Zairians with AIDS and from 5 (55%) of 9 patients with AIDS-related complex (ARC). In addition, 5 (19%) of 27 controls admitted to Zaire's Mama Yemo Hospital for causes unrelated to AIDS were found to be positive for antibodies to HIV. Next, an effort was made to isolate the virus from 42 AIDS or ARC patients on whom data were already available on the results of an enzyme-linked immunosorbent assay (ELISA). HIV was isolated from 30 (81%) of 37 patients with positive ELISA tests and from none of the 5 patients with a negative assay. Among controls, antibodies were found in a higher proportion of patients with abnormal helper: suppressor ratios or a low absolute T helper cell count. On the other hand, these abnormalities were not found in 3 of the 5 control patients from whom HIV was isolated, including 2 without HIV antibody. This suggests that neither of these criterion are good indicators of virus infection. The isolation of HIV infection from 5 hospital controls with no clinical signs of infection suggests that either the rate of asymptomatic HIV virus infection is high in Zaire or that common tropical diseases such as malaria or tuberculosis may be associated with HIV infection. The frequency of HIV isolation from AIDS and ARC patients in this study is higher than that in earlier reports from non-Africans, but is comparable to current statistics from the US.
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PMID:Isolation of human immune deficiency virus from African AIDS patients and from persons without AIDS or IgG antibody to human immune deficiency virus. 294 38

The epidemiologic and social aspects of AIDS are different in developed and developing countries. In Africa, where there are several tens of thousands of cases, the ratio of female to male cases is 1:1. The highest incidence in men is at age 37.4 and in women 30 years. In Haiti the female to male ratio is 1:1.8. In Rwanda and Zambia the incidence is higher among educated people. In most of Africa AIDS is predominantly urban. Also, in Africa the time between diagnosis and death is shorter. Seroprevalence rates in Africa and the Caribbean are between .5 and 18% for the population at large. In Zaire seroprevalence peaks between ages 16-20 and at under 1 year. Both in the US and in Africa the epidemic appears to have begun around 1980. In West Africa a related virus, HIV-2, has been identified. Progression rates from seropositivity to AIDS or AIDS-related complex in Africa are similar to those in the US. However, in Africa, and recently in Haiti, transmission has been heterosexual. In Africa female prostitutes have the highest incidence of HIV seropositivity, and there is much female to male transmission via this route. Genital ulcers, especially chancroid, increase the risk of AIDS, and condom use may protect women from infection. The 2nd most important route of AIDS transmission in Africa and Haiti is blood transfusion. Blood transfusion are common in treatment of children with anemia from malaria and with sickle cell anemia, and many children have been infected via this route in Africa. Medical injections, scarification and circumcision also account for HIV transmission. Perinatal transmission from seropositive mothers is also common in Africa. Among patrilineal African societies premarital or extramarital sex is rare among girls, but young men and husbands of nursing mothers often visit prostitutes. In the cities there are varying degrees of promiscuity. In couples where the husband is seropositive, he usually has a history of sex with prostitutes, but in couples where the wife is seropositive, she usually has a history of blood transfusion.
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PMID:Epidemiological and sociological aspects of HIV-infection in developing countries. 305 51

In this paper we provide an account of our experience in the application of remote sensing (RS) and geographic information system (GIS) in understanding malaria transmission dynamics at the local level. Two studies have been briefly reviewed. One is the application of RS on the mosquito production in the Sanjay lake and surrounding areas in Delhi. Studies are demonstrated that remote sensing data were useful in assessing relative mosquito abundance from large water bodies. The second study was carried out in Nadiad taluka, Kheda district, Gujarat on the application of RS and GIS in a village-wise analysis of receptivity and vulnerability to malaria. For this study, remote sensed data and topo sheets of 1:50,000 and 1:125,000 were used in preparing thematic maps. Digitised overlaid maps were subjected to computer analysis using ARC/INFO 3.1 software. Malaria annual parasite incidence (API) showed relationship with water table followed by soil type, irrigation and water quality, other parameters also contributed to malaria receptivity but less significantly. Based on GIS analysis location specific malaria control strategy was suggested to achieve cost effective control of malaria on a sustainable basis.
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PMID:Role of geographic information system in malaria control. 929 87

The Ministry of Health and WHO recommend establishment of a National AIDS Advisory Council in Zambia with that country's president or vice president leading it to strengthen AIDS prevention efforts. They conclude that HIV/AIDS is a major health problem in Zambia. Other advice includes more resources for caring for AIDS cases, improvement of AIDS reporting, and creation of a national board or committee on blood transfusion. The National Council would unify policies and activities of the National AIDS Prevention and Control Programme (NAPCP) and guarantee more government funding for NAPCP. Yet the Deputy Minister of Health does not support its creation because the country's new government, which came into power in late 1991, wants to create a National Health Council with various committees centering on different health issues including AIDS. Yet the new government has not paid any more attention to AIDS than the prior government. Instead it puts most of its efforts into reconstructing the bankrupt economy and paying off the country's debt. The new Minister of Health claims health workers are putting too much emphasis on AIDS while malaria kills more people than does HIV. The new government has tried to distribute more drugs in the health care system, however. AIDS health workers always face shortages in medical supplies, drugs, transportation, and accommodation. 75% of patients at urban hospitals are at least HIV infected, up from 13% in 1986. This is evidence of how HIV/AIDS is already burdening the system. By December 1991, the number of recorded AIDS and AIDS Related Complex cases was 24,519 but the actual number is probably much higher. The new government hopes to engage private companies in the fight against AIDS. It also intends to mainstream AIDS into the health care and education system particularly in rural areas.
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PMID:Does Zambia need a national AIDS council, Uganda-style or is that "tunnel vision"? 1231 23

The World Health Organization (WHO) has issued exaggerated projections about AIDS deaths that the press picked up to paint an apocalyptic future for Africa. Computer models used by WHO estimate that 2-3 million people in Africa are suffering or have died from AIDS since the early 1980s and another 10 million are carrying HIV. WHO surveys during 1987 indicated HIV seroprevalence rates from 5% to 30%. The Global Program on AIDS (GPA) utilized these data to predict 6.5 million new AIDS deaths annually by 1997, which would reduce population growth in urban areas by over 30%. This projection seems to be an exaggeration. The same 1987 figures were used to predict AIDS deaths for 1992. Using the highest seroprevalence rate of 30%, the WHO model predicted a high scenario of 6 million new AIDS deaths in 1992, when in fact the cumulative cases were only 331,376 in 1994. Even the low scenario of a 5% seroprevalence rate predicted 750,000 new AIDS cases for 1992, whereas the 1% rate suggested 500,000 new AIDS cases. Another projection made in 1994 estimated only 350,000 new AIDS cases for Africa in 1994. The discrepancies between projections and recorded figures are attributable to lack of statistical data and reliable reporting of mortality. National estimates are derived from censuses and surveys which are overextrapolated. Since 1985, AIDS has been defined in Africa on the basis of clinical observation (chronic diarrhea or prolonged fever and persistent cough or herpes) because of lack of HIV testing facilities. However, it is impossible to tell whether someone who develops malaria does so because of AIDS or because of normal impaired immunity. This definition has inflated the estimated AIDS figures. The danger of the AIDS epidemic is dwarfed by 3.5 million deaths from tuberculosis and 16.8 million deaths from malaria since the beginning of the AIDS epidemic. The frightening scenario looms that widespread, but curable, diseases are wrongly classified as AIDS-related complex, thereby foregoing appropriate treatment.
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PMID:WHO criticised for "inflating" AIDS figures. 1231 62