Trends of AIDS in Guadeloupe (French West Indies): A longitudinal survey from 1998 to 1997

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.(AU)

Clustering of cases of mycobacterium fortuitum infection investigated by molecular typing

Organisms of the mycobacterium fortuitum complex are recognised but uncommon causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M fortuitum was isolated from 20 patients over a 15 month period, with a apparent clustering of isolates occurring from January to March 1994. The molecular epidemiology of this clustering eas investigated using an arbitrary primer polymerase chain reaction method (AP-PCR). 21 isolates were studied, which yielded 13 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates recovered during the six week period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was isolated from specimens from all seven patients. The source of this cluster in uncertain. We can find no epidemilogical basis for an episode of cross-infection within the hospital environment, and it is assumed that contamination of the specimens during collection, transport or processing was responsible for the "pseudo-outbreak" of M fortuitum

Preventing opportunistic infections in human immunodeficiency virus-infected persons: implications for the developing world

More than 18 million persons in the the world are estimated to have been infected with human immunodefeiciency virus (HIV), the cause of the acquired immunodeficiency syndrome (AIDS). As immunodeficiency progresses, these persons become susceptible to a wide variety of opportunistic infections (OIs). The spectrum of OIs varies among regions of the world. Tuberculosis is the most common serious OI in sub-Saharan Africa and is also more common in Latin America and in Asia than in the United States. Bacterial infections such as toxoplasmosis, cryptosporidiosis, and isosporaisis are also common in Latin America. Fungal infections, including cryptococcosis and Penicillium marneffei infection, appear to be prevalent in Southeast Asia. Despite limited health resources in these regions, some measures that are recommended to prevent OIs in the United States may be useful for prolonging and improving the quality of life of HIV-infected persons. These include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pnemococcal vaccine to prevent disease due to Streptococcus pneumoniae. Research is needed to determine the spectrum of OIs and the efficacy of various prevention measures in resource-poor nations, and health officials need to determine a minimum standard of care for HIV-infected persons. An increasing problem in the developing world, HIV/AIDS should receive attention comparable to other tropical diseases (AU).

Parasitic infections associated with HIV/AIDS in the Caribbean

This review article seeks to highlight the significance for the Caribbean of major parasitic infections associated with AIDS, encourage awareness of these opportunistic parasites, and promote familiarity with appropriate diagnostic techniques and their clinical relevance. Specific agents considered include Pneumocystis carinii; Toxoplasma gondii; the enteric coccidians Crytosporidium spp., Isospora belli, and Cyclospora cayetanensis; the hemoflagellates Leishmania spp. and Trypanosoma cruzi; the fungi Histoplasma capsulatum and Cryptococcus neoformans; the nematode Strongyloides stercoralis; and the mite Sarcoptes scabiei. These disease agents can be divided into two groups, the immune-regulated "endogenous" parasites (the protozoans P. carinii and T. gondii, and possibly the roundworm S. stercoralis) and intracellular parasites (including the enteric coccidia, hemoflagellates, and fungi). Both in the Caribbean and elsewhere, the endogenous parasites (particularly P. carinii and T. gondii) are the most troublesome for AIDS patients, partly because they are likely to be transmitted and establish a benign immunoregulated presence early in the subjects's life. Indeed, health management programs for AIDS patients often routinely include P. carinii prophylaxis, since nearly all such patients who survive long enough are expected to experience an episode of acute P. carinii infection. In contrast, there is no known epidemiologic association between AIDS and strongyloidiasis in the Caribbean, and the prevalence there of potentially opportunisitc hemoflagellates such as Leishmania spp. and Trypanosoma cruzi is relatively low (AU)