Increased risk of infection with human immunodeficiency virus type 1 among uncircumcised men presenting with genital ulcer disease in Kenya.

The factors responsible for the explosive spread of human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa continue to be identified and debated. One of the most controversial factors has been male circumcision. This cross-sectional study was conducted to measure the association between circumcision status and infection with HIV-1 among men with genital ulcer disease. Eight hundred and ten men participated in the study, of whom 190 (23%) were HIV-1-positive. A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) and with a history of urethral discharge (adjusted OR, 2.0; 95% CI, 1.4-2.8). This association could not be explained by measures of sexual exposure to HIV-1 among this population. Male circumcision should be considered as an intervention strategy for AIDS control.

Herpes zoster as the initial presentation of human immunodeficiency virus type 1 infection in Kenya.

We conducted a prospective observational study to determine the clinical features, the degree of immunosuppression, and the prevalence of human immunodeficiency virus type 1 (HIV-1) infection associated with herpes zoster in Kenya. The study included 196 HIV-1 positive individuals and 34 HIV-1 negative individuals between the ages of 16 and 50 years who presented to a referral clinic in Nairobi. Comparison of the clinical characteristics in the two groups found that the duration of illness in the HIV-1-positive group was longer (32 vs. 22 days; P < .001) and that the HIV-1-positive group was more likely to have generalized lymphadenopathy (74% vs. 3%; OR: 12.2; 95% CI: 1.6, 91.7), severe pain (69% vs. 39%; OR: 3.6; 95% CI; 1.7, 7.6), bacterial superinfection (15% vs. 6%; OR: 5.7; 95% CI: 1.3, 25.0), and more than one affected dermatome (38% vs. 18%; OR: 2.8; 95% CI: 1.1, 8.0). Dermatomal distribution of the lesions was similar in the two groups, except for cranial lesions, which occurred exclusively in the HIV-1-positive group. The mean CD4 T lymphocyte count at presentation was 333/mm(3) in the HIV-1-positive group and 777/mm(3) in the HIV-1-negative group (P < .001). Herpes zoster is often recognized as the initial HIV-1-related illness in Kenya despite the fact that patients have moderate to severe depression of CD4 cell counts at presentation. Although the clinical features of herpes zoster may be more severe in HIV-1-positive individuals, recovery is generally complete and uncomplicated.

Sexual behavior and perceived risk of AIDS among men in Kenya attending a clinic for sexually transmitted diseases.

The sexual transmission of human immunodeficiency virus type 1 (HIV-1) continues at an alarming rate in sub-Saharan Africa despite the fact that awareness of AIDS is high. One explanation for this alarming rate may be that individuals do not believe that they are personally at risk for AIDS and are not sufficiently motivated to make changes in their behavior. We conducted a cross-sectional study of men with genital ulcer disease to assess their sexual behavior and their perceived risk of AIDS. We studied 787 men between the ages of 17 and 54 years who presented to a referral clinic for sexually transmitted diseases (STDs) in Nairobi, Kenya. Of these 787 men, 188 (24%) were infected with HIV-1. Awareness of AIDS was essentially universal in this population; however, only 64 men (8%) thought that they were personally at risk of developing AIDS. A logistic regression analysis found that men who believed they were personally at risk knew someone with AIDS (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.0-19.7), received information about AIDS from television or video (OR, 3.0; 95% CI, 1.7-5.5), or had previously had an STD (OR, 2.2; 95% CI, 1.2-4.1). Except for a modest increase in condom use, there was no significant difference in sexual behavior between the group who considered themselves to be at risk for AIDS and the group who did not consider themselves to be at risk. The results of this study challenge the current strategies on HIV/AIDS education and prevention for urban men in Kenya.

Single dose azithromycin for the treatment of chancroid: a randomized comparison with erythromycin.

BACKGROUND AND OBJECTIVES: Chancroid is endemic in sub-Saharan Africa and enhances the sexual transmission of the human immunodeficiency virus Type 1 (HIV-1). Azithromycin is an orally absorbed macrolide antibiotic that is active against Haemophilus ducreyi, the causative agent of chancroid, and has pharmacokinetic properties that are suitable for single dosing. STUDY DESIGN: In a randomized single-blinded study of 127 men presenting to a referral STD clinic with culture proven chancroid, we compared the efficacy of azithromycin, administered as a single 1 g dose, with erythromycin 500 mg given 4 times daily for 7 days. RESULTS: Cure rates were 89% (73 of 82) in the azithromycin group and 91% (41 of 45) in the erythromycin group. A failure to respond to treatment was associated with HIV-1 seropositivity and a lack of circumcision. Both regimens were well tolerated. CONCLUSIONS: Azithromycin, given as a single 1 g oral dose, is an effective treatment for chancroid in men, and offers major prescribing advantages over erythromycin.

Fleroxacin in the treatment of chancroid: an open study in men seropositive or seronegative for the human immunodeficiency virus type 1.

Fleroxacin was prescribed to treat both HIV-negative and HIV-positive men with proven chancroid in an open study. HIV-negative men were treated with a single 400-mg dose of fleroxacin, and HIV-positive men were treated with 400 mg daily for 5 days. Three of the 58 evaluable HIV-negative men were clinical and microbiologic failures, and two of the 22 evaluable HIV-positive men had persisting infection with Haemophilus ducreyi. Both regimens were well tolerated. Fleroxacin is an acceptable alternative to existing treatment regimens for chancroid in men.