Differential of HIV prevalence in women and men who attended sexually transmitted disease clinics at HIV sentinel surveillance sites in Kenya, 1990-2001.

Several studies in sub-Saharan Africa have reported that HIV prevalence in young women is higher than in young men. We used data from Kenya HIV sentinel surveillance conducted from 1990 to 2001 among sexually transmitted disease (STD) patients (15-49 years old) to investigate consistency of gender differentials over time and their risk factors. Of the 15,889 STD patients, the HIV prevalence ranged from 16.0% in 1990 to 41.8% in 1997. The odds ratios (ORs) of HIV infection for women compared to men decreased by age; women 15-24 years were nearly twice as likely as men of the same ages to be HIV infected (OR 1.7 [1.5-2.0]), but risk in those >44 years was almost equal (OR 0.8 [95% CI 0.7-1.2]). The odds of HIV infection for women compared to men were twice in unmarried patients (OR 2.1 [95% CI 1.8-2.3]). This association persisted after controlling for age groups or marital status, residence, level of education, and presence of STD syndromes. This pattern had been consistent over 12 years. Adolescent women with symptoms of STDs should be a focus for the HIV/STD intervention programmes because of their high risk for HIV.

HIV-associated tuberculosis in the era of highly active antiretroviral therapy. The Adult/Adolescent Spectrum of HIV Disease Group.

OBJECTIVE: To determine the effect of highly active antiretroviral therapy (HAART) on the risk of tuberculosis (TB) among persons infected with the human immunodeficiency virus (HIV), and to examine trends in TB. METHODS: For the risk factor analysis, we examined data from the Adult/Adolescent Spectrum of HIV Disease (ASD) project from January 1996 through June 1998. ASD is an observational cohort study conducted in over 100 clinics and hospitals in 11 US cities. Poisson regression was used to model the incidence of TB while controlling for HIV-exposure mode, race, country of birth, CD4 count, TB preventive therapy, and half-year of diagnosis. We also examined trends in TB incidence January 1992 to June 1998. RESULTS: During the risk factor analysis period, 80 cases of TB occurred in 16,032 person-years (5.0 cases/1000 person-years). In multivariate analysis, the risk of TB was much lower among persons prescribed HAART (RR = 0.2, 95%CI 0.1-0.5, P < 0.001), and also lower among persons prescribed other antiretroviral therapy (RR = 0.6, 95% CI 0.4-1.0, P = 0.05), than the risk in persons not prescribed antiretroviral therapy. In addition, TB rates declined from January 1992 to June 1998 (P < 0.001). CONCLUSION: Widespread use of HAART reduced the risk for TB and may help bring about further declines in TB among persons infected with HIV.

Tracking the HIV epidemic: current issues, future challenges.

The emergence of a new infectious disease, AIDS, in the early 1980s resulted in the development of a national AIDS surveillance system. AIDS surveillance data provided an understanding of transmission risks and characterized communities affected by the epidemic. Later, these data provided the basis for allocating resources for prevention and treatment programs. New treatments have dramatically improved survival. Resulting declines in AIDS incidence and deaths offer hope that HIV disease can be successfully managed. However, to prevent and control HIV/AIDS in the coming decades, the public health community must address new challenges. These include the defining of the role of treatment in reducing infectiousness; the potential for an epidemic of treatment-resistant HIV; side effects of treatment; complacency that leads to relapses to high-risk behaviors; and inadequate surveillance and research capacity at state and local levels to guide the development of health interventions. Meeting these challenges will require reinvesting in the public health capacity of state and local health departments, restructuring HIV/AIDS surveillance programs to collect the data needed to guide the response to the epidemic, and providing timely answers to emerging epidemiologic questions.

HIV drug strategies in the West--and AIDS everywhere else. An interview with Kevin M. DeCock, MD, FRCP, DTM&H. Interview by Mark Mascolini.

AIDS: Dr. Kevin M. DeCock, a physician with broad experience in infectious and tropical diseases, discussed the use of anti-HIV drugs in the West and the status of AIDS in the rest of the world. Dr. DeCock explained the importance of finding the right physician to help HIV-positive individuals direct their decisions on when to start therapy, when to switch it, and when to stop therapy. Offering preventive anti-HIV therapy, similar to treating health personnel exposed to blood of an infected patient, may become a possibility. Dr. DeCock briefly discussed subtypes of the virus that exist in different populations, and physiological and transmission features of the subtypes. Problems faced in developing countries in treating and preventing HIV infections include factors arising due to poverty, lack of medical resources, and cultural factors. A series of research priorities was suggested to prevent the spread of the disease in these resource-poor countries. Other areas discussed were prevention of perinatal HIV transmission using antiretroviral therapy, the severe problem of tuberculosis in HIV infections, especially in developing countries, and the inadequate attention Westerners give to these problems.^ieng

[Prevalence of pneumocystosis in HIV infected patients in a pneumology unit. Autopsy study performed in Abidjan (Côte d'Ivoire)]. / Prévalence de la pneumocystose chez les sujets infectés par le VIH dans un service de pneumophtisiologie. Etude autopsique réalisée à Abidjan (Côte d'Ivoire).

Autopsies were performed in the Pathology Department of the Treichville University Hospital, Abidjan, Ivory Coast in 70 HIV infected subjects who had died in the Department of Pneumophtisiology. The prevalence of Pneumocystis carinii pneumonia was determined. None of the patients had received prophylaxis against P. carinii and none had bee treated for pneumocystosis. Autopsies were performed within 6 to 48 hours after death and the diagnosis of pneumocystosis was confirmed with the Gomori-Grocott staining technique on lung specimens. Among the 70 autopsies Pneumocystis carinii pneumonia was observed in 6. Thus the prevalence of P. carinii pneumonia in these patients infected with HIV was 8.57%.

[Pulmonary diseases and retrovirus infections. A pathological study in 70 cases]. / Pathologie pulmonaire et infection rétrovirale. Etude nécropsique de 70 cas.

A necroscopic study, conducted in the Pathology Department of the Centre Hospitalier Universitaire (CHU) de Treichville in Abidjan, included 70 seropositive subjects who died in the Pneumophtisiology Department. We attempted to determine the different pulmonary affections occurring during infection with the human immunodeficiency virus (HIV). This study demonstrated the predominant role of tuberculosis (44%) and bacterial pneumonia (30%) which remain the predominant aetiologies. Other opportunistic affections were rare including: Pneumocystises, Mycobacteriaceae, and Cytomegalovirus infection and the Kaposi sarcoma. The absence of pulmonary cryptococcosis and non-Hodgkin lymphoma were also noted. Necroscopic examinations do not necessarily provide evidence of the in vivo pathologies, the autopsy being able to identify only the causal diseases or those present at death.

Prevalence of hepatitis delta (delta) virus infection. A seroepidemiologic study.

In assessing the prevalence of hepatitis delta (delta) virus (HDV) infection in 358 patients with acute hepatitis B seen in Los Angeles between 1983 and 1985 and in 196 patients with chronic hepatitis B followed between 1980 and 1985, we found that 23% of patients with chronic and 5% of patients with acute hepatitis B were infected with HDV. Among patients with chronic hepatitis B, the prevalence of HDV infection was 73% in intravenous drug users and 14% in homosexual men. Acute coinfection with the hepatitis B virus was also more frequent in drug users (8%) than in other groups. delta-Hepatitis is a common infection in hepatitis B virus carriers in Los Angeles, particularly in drug addicts, but also in homosexual men who do not abuse drugs intravenously.

Serum hepatitis B virus DNA in acute hepatitis B.

With the use of the dot blot hybridization technic, sera from 30 consecutive patients with acute hepatitis B were examined for the presence of hepatitis B virus (HBV)-DNA. In an additional five patients with acute hepatitis B, serial serum samples, beginning before the serum alanine amino transferase elevation to the clearance of hepatitis B surface antigen, also were tested for various hepatitis B virus markers, including HBV-DNA. Thirteen of the 30 patients (43%) had circulating HBV-DNA and HBeAg at the time of their first clinic visit. However, 11 additional patients with HBeAg did not have HBV-DNA in their sera. In the 13 patients with HBV-DNA, there was no correlation between the titers of HBeAg and the levels of HBV-DNA. Examination of the serial serum samples from the additional five patients showed HBV-DNA and HBeAg to be present several days before the peak of serum alanine amino transferase. In all five patients, HBV-DNA was present in the serum before the appearance of IgM anti-HBc. However, HBsAg was present in all these patients' sera at the time of HBV-DNA positivity. None of the patients in this study became chronic carriers of hepatitis B virus.

Delta viral hepatitis. Histopathology and course.

Delta viral hepatitis is important to recognize on hepatic tissue as its presence may explain severe or fulminant acute viral hepatitis, "relapse" of acute viral hepatitis, fulminant acute viral hepatitis in a chronic hepatitis B carrier, exacerbation of previously silent chronic active hepatitis, and the change in course of persistent viral hepatitis to progressive chronic active hepatitis. Histologic clues to support delta infection are primarily the severity of hepatocellular necrosis and inflammatory response. Specific immunologic procedures are required for diagnosis and include serum testing (antigen, antibody for IgG and IgM types) and antigen detection in tissue by immunofluorescence or immunoperoxidase staining. This agent is currently important as a cause of hepatitis in IV drug users, male homosexual patients, and recipients of blood products. Further studies are needed with careful accurate classification of hepatitis B patients in order to recognize the pattern of spread, severity, and outcome of delta hepatitis in other populations.