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).

Treatment of sickle cell disease in early childhood in Jamaica

The Jamaican sickle cell cohort study, based on neonatal diagnosis of all cases of sickle cell disease among 100 000 consecutive births, has identified acute splenic sequestration (ASS) and pneumoccocal disease as the most important complications in early life. The etiology of ASS is unknown and prophylaxis is therefore not possible. For first attacks, attention has been directed to parental education to achieve earlier diagnosis. Recurrent attacks may be prevented by prophylactic splenectomy. A controlled trial on the prevention of pneumococcal disease has indicated many pneumococcal septicemias in children given the 14 valent pneumococcal vaccine between the ages of 6 months and 3 years. No pneumococcal isolations occurred during the same period in children given monthly long-acting prophylactic penicillin. A controlled trial of foliate supplementation for 1 year in children aged 6 months to 4 years indicated no difference between control and treatment groups in hemoglobin levels or weight and height velocity. The MVC was 4 fl less in the supplemented group. A controlled trial of feeder vessel photocoagulation in the therapy of proliferative retionpathy indicated significantly less vitreous hemorrhage in treated patients but choroidal neovascularization was a common complication of xenon arc therapy and retinal tears commonly followed the use of Argon laser. A new trial of scatter therapy is in progress. (AU)

Safety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age

64 healthy infants, 2-3 months old, were randomly assigned to one of three vaccination groups which either diphtheria-pertussis-tetanus (DPT) vaccine, Haemophilus influenzae type b capsular polysaccharide polyribosyl-ribitol phosphate (PRP) vaccine, or PRP+P (with pertussis adjuvant) vaccine in three doses at intervals of two months. Local and systemic reactions occurred most frequently after DPT vaccination and least frequently for PRP alone. Data for 60 infants from whom complete sera sets were available indicated that 70 percent of the infants who received three doses of PRP+P showed two fold or greater increases in titers of antibody to PRP with final values above the level assumed to give protection against invasive H. influenzae type b disease (>0.15 ug/ml). In contrast, less than 10 percent of infants who received PRP vaccine alone showed 2-fold or greater increases (Summary)

Iron absorption and pyrexia

An incidental finding led to a more detailed study of the effect of fever on iron absorption. The absorption of 59Fe-labelled ferrous ascorbate was measured by whole-body counting in nineteen malnourished Jamaican infants and young children. Tests were done at various stages of refeeding, and it was found that the presence of a febrile illness or the febrile response to diptheria-pertussis-tetanus immunisation profoundly depressed iron absorption. This effect was not related to the nutritional state of the patient. Recurrent minor febrile illnesses are common in this group of children and may contribute to the production of iron deficiency.(Summary)