RESUMEN
BACKGROUND: Clinical outcomes for patients with Kaposi's sarcoma (KS) using nonnucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART) in resource-limited settings have not previously been described. METHODS: We evaluated HIV-infected patients aged ≥ 18 years, who initiated HAART in the Home-Based AIDS Care (HBAC) project in Tororo, Uganda, between May 2003 and February 2008 and were diagnosed with KS at baseline or during follow-up. We examined independent risk factors for having either prevalent or incident KS and risk factors for death among patients with KS. RESULTS: Of 1121 study subjects, 17 (1.5%) were diagnosed with prevalent KS and 18 (1.6%) with incident KS over a median of 56.1 months of follow-up. KS was associated with male sex [adjusted odds ratio (AOR) 2.41; 95% confidence interval (CI) 1.20-4.86] and baseline CD4 cell count < 50 cells/µL (AOR 3.25; 95% CI 1.03-10.3). Eleven (65%) of 17 patients with prevalent KS and 13 (72%) of 18 patients with incident KS experienced complete regression (P = 0.137). Eighteen (64%) of 28 patients who remained on NNRTI-based HAART experienced regression of their KS and six (86%) of seven patients who were switched to protease inhibitor-containing HAART regimens had regression of their KS (P = 0.23). Mortality among those with KS was significantly associated with visceral disease (hazard ratio 19.22; 95% CI 2.42-152). CONCLUSION: Prevalent or incident KS was associated with 30% mortality. The resolution of KS lesions among individuals who initiated HAART with NNRTI-based regimens was similar to that found in studies using only protease inhibitor-based HAART.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Sarcoma de Kaposi/tratamiento farmacológico , Adulto , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Femenino , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Masculino , Estudios Prospectivos , Sarcoma de Kaposi/epidemiología , Sarcoma de Kaposi/inmunología , Resultado del Tratamiento , Uganda/epidemiología , Carga Viral/efectos de los fármacosRESUMEN
SETTING: Reliable clinical algorithms that screen for active tuberculosis (TB) in human immunodeficiency virus (HIV) infected people initiating or receiving antiretroviral treatment (ART) in sub-Saharan Africa could reduce the need for diagnostic procedures. METHODS: We estimated the utility of six TB-related signs and symptoms, alone or in combination, compared with the Uganda Ministry of Health diagnostic guidelines for participants with prevalent (baseline), early ART (< or = 3 months on ART) and incident TB (>3 months on ART). RESULTS: Of 1995 participants screened for ART eligibility, 71 (3.6%) had prevalent TB. The presence of any one of the following: cough > or = 3 weeks, fever > or = 4 weeks, lymphadenopathy or baseline body mass index < or = 18 kg/m(2) had a sensitivity of 99% (95%CI 96-100), a specificity of 66% (95%CI 64-68) and a negative predictive value (NPV) of 100% (95%CI 99-100) for predicting active TB. During ART follow-up, TB incidence was 2.4 (95%CI 1.6-3.4)/100 person-years. The presence of cough > or = 3 weeks or general weakness was 100% sensitive (95%CI 99-100), 66% specific (95%CI 59-74) and had an NPV of 100% (95%CI 99-100). CONCLUSION: Use of a simple TB screening algorithm can accurately identify, in a resource-poor African setting, HIV-infected individuals who require further procedures to diagnose active TB.
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Algoritmos , Infecciones por VIH/epidemiología , Tamizaje Masivo/métodos , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Adulto , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Población Rural/estadística & datos numéricos , Sensibilidad y Especificidad , Uganda/epidemiologíaRESUMEN
OBJECTIVES: To identify pathogens associated with diarrhoea in HIV-infected persons and their HIV-uninfected family members. DESIGN: Prospective cohort study. SETTING: Rural community in eastern Uganda. SUBJECTS: Eight hundred and seventy nine HIV-infected adults (74% females and median age 35 years (IQR, 29-41) and 2771 HIV-uninfected family members (51% females and median age 11 years (IQR 6-16) were included. MAIN OUTCOME MEASURES: Using microscopy and culture, stools were tested for parasites, bacteria and bacterial-antimicrobial-susceptibility. Logistic regression models, adjusting for age, CD4 cells, season, household clustering and use of safe-water system were used for relationships between pathogens, diarrhoea and HIV. RESULTS: Persons with HIV had similar pathogens in diarrhoeal (69%) and nondiarrhoeal stools (57%). Most diarrhoea was not associated with identifiable aetiology; the population attributable risk of diarrhoea for known diarrhoea pathogens was 32%. Enteric bacteria (19%), enteropathogenic or enterotoxigenic E. coli (8%), Aeromonas species (7%), Strongyloides stercoralis (8%) and Cryptosporidium parvum (5%). HIV-infected, stools had more Cryptosporidium parvum than HIV-uninfected (OR 2.64, 95% CI 1.43-4.87). Most bacteria were resistant to commonly used antimicrobials irrespective of HIV status. CONCLUSIONS: Irrespective of HIV-status, aetiologies of majority of their diarrhoea in Uganda cannot be identified by microscopy and culture. Bacterial pathogens isolated have high resistance to common antimicrobials. Empiric treatment should be tailored to local bacterial-resistance patterns.
Asunto(s)
Diarrea/microbiología , Diarrea/parasitología , Infecciones por VIH/epidemiología , Adulto , Heces/microbiología , Heces/parasitología , Femenino , Humanos , Masculino , Estudios Prospectivos , Población Rural , UgandaRESUMEN
CD4+-cell count and viral load monitoring are expensive and unavailable to most human immunodeficiency virus (HIV)-infected people in Africa. In an attempt to evaluate alternative methods for monitoring antiretroviral (ARV) therapy, we measured concentrations of immunoglobulin (Ig)A, IgM, IgG and IgG1 amongst adults with and without HIV in Uganda and Norway. We adjusted for disease severity by stratifying HIV-positive subjects on CD4+-cell counts above and below 200 cells/ micro l. Median serum levels of IgG, IgG1 and IgA were significantly higher in HIV-positive persons compared with HIV-negative persons in both countries (P < 0.001 and P = 0.018 for IgA in Ugandan patients). Levels of IgA in Ugandan HIV-negative subjects were significantly lower than those in HIV-positive subjects with low CD4+ compared with those with high CD4+-cell counts (P < 0.001 and P = 0.069, respectively). IgM levels were different between the HIV-negative and the two HIV-positive groups in Norway (P < 0.001). The mean levels of IgM, IgG and IgG1 in HIV-negative and -positive African subjects were generally higher than those in comparable groups of Western subjects. Our results verify that levels of IgA, IgG and IgG1 vary between HIV-negative and -positive individuals in both study populations. Their determination may be useful in monitoring both disease progression and response to ARV therapy.
Asunto(s)
Infecciones por VIH/inmunología , VIH-1/inmunología , Inmunoglobulinas/sangre , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Relación CD4-CD8 , Linfocitos T CD4-Positivos/inmunología , Femenino , Infecciones por VIH/sangre , Humanos , Isotipos de Inmunoglobulinas , Masculino , Persona de Mediana Edad , Noruega , Estadísticas no Paramétricas , UgandaRESUMEN
BACKGROUND: It is still unclear whether short interpregnancy intervals are a marker for women at risk of poor pregnancy outcome or a direct risk factor for poor perinatal outcomes. The study objective was to identify risk factors associated with short interpregnancy intervals in Denmark. METHODS: From a cohort of pregnant women in a geographically defined area in Denmark (n=11,288) and using register linkage, we identified 5756 multiparous mothers who completed a detailed interview on social behavior during pregnancy. We restricted our analysis to 2904 mothers who had an interpregnancy interval of less than 37 months. Multiple logistic regression was used to estimate the Odds Ratio (OR) of having a short interval as a function of a number of determinants. RESULTS: About 4.8% of the mothers had an interpregnancy interval less than 9 months. Short interpregnancy intervals were more likely to occur in an unplanned pregnancy (OR=2.9, 95% CI: 2.2-3.9), to follow irregular menstruation (OR=1.7, 95% CI: 1.1, 2.5) and to occur in older (OR=1.7, 95% CI: 1.1, 2.5) and high parity mothers (OR=1.9, 95% CI: 1.1, 3.1). Poor housing, smoking and low social status were also associated with short interpregnancy interval CONCLUSION: Short interpregnancy intervals may be a marker for women at risk and these risk factors differ among populations. They also appear to be a result of choice (e.g. in older women). Biological factors also play a significant role in determining short interpregnancy intervals.
Asunto(s)
Intervalo entre Nacimientos , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Adolescente , Adulto , Estudios de Cohortes , Intervalos de Confianza , Dinamarca/epidemiología , Femenino , Humanos , Modelos Logísticos , Edad Materna , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Paridad , Embarazo , Medición de Riesgo , Factores de Riesgo , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To estimate the rate of and risk factors associated with child mortality in rural eastern Uganda. DESIGN: A community based cross-sectional study using the preceding birth technique--a robust method of obtaining information of survival of the previous child. SETTING: A rural district in Eastern Uganda. PARTICIPANTS: In total, 2888 multigravidae were interviewed in April and May 1999. MAIN OUTCOME MEASURE: Number of deaths among children born alive. RESULTS: The under-two child mortality rate was 108 per 1000 livebirths. The annual child mortality was 82 per 1000 child-years of risk. Child mortality was associated with low parental education, being born to adolescent mothers or mothers aged 35 or more. Unconditional logistic regression showed that children born to uneducated parents had a doubled risk of not celebrating their second birthday. It was three times more likely for a child to die in the neonatal period than in the first year of life. Child mortality risk decreased by 4% and 6% for every year of education attained by mothers and fathers, respectively. Parity, residence and marital status were not associated with excess risk of child mortality. Seasonal mortality followed the El Nino rainfall pattern. Finally, there were geographical differences in child mortality although this was not statistically significant. CONCLUSION: Monitoring trends in child mortality at district level can be done using the preceding birth technique in antenatal settings. Maternal education, an important predictor of child survival should be included in routine data collection at clinics.