Severe primary HIV-1 infection among black persons in Barbados

Descriptions of primary HTV-1 infection have so far been based on Caucasians living in industrialized nations. Due to studies of leptospirosis in predominantly black population of Barbados, serum was available for patients admitted with acute febrile illnesses to the Queen Elizabeth Hospital (QEH). By searching the medical records of 510 adult patients with known HIV-1 infection we identified 10 patients who had stored serum from an admission for an acute febrile illness that predated or coincided with their first HIV-1-positive test. Serological testing confirmed primary HIV-1 infection in 9 and was suggestive in the 10th patient. The clinical features of these 10 patients were in keeping with previous descriptions of primary HIV-1 infection but differed from leptospirosis cases seen at the QEH. One patient died during the seroconversion illness and another died 3 months after seroconversion. The findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.(AU)

The Barbados AIDS audit: patient contact with surgical services and accident and emergency - abstract

The records of 653 adult HIV-positive patients, covering the period July 1984 to June 1995, were reviewed to determine patient contact with surgical services at the Queen Elizabeth Hospital (QEH). The relationship of the Accident & Emergency (A&E) attendance prior to admission and survival was also assessed for first respiratory admissions. The balance of care between the HIV clinic at the QEH and the A&E department was also assessed. Surgical outpatient contact chiefly comprised consultations for ano-genital warts and follow appointment after admissions. There were 50 admissions (5 deaths) on the surgical wards out of a total of 1059 admissions. Ischiorectal abcesses were the cause of eight admissions and five patients were admitted after a fight; other admissions were for a wide range of reasons. Eight patients had a lymph node biopsy (4 whilst on medical wards) reflecting the conservative approach to lymphadenopathy in Barbados. Admission from the A&E was the most frequent route of admission associated with a worse outcome. There was no trend to decrease involvement in ambulatory care by A&E over time. In conclusion, the audit has shown that the A&E Department must be a focus for improving care. (AU)

The Barbados AIDS audit: a profile of first respiratory admissions

Lower respiratory tract infections (LRTI) are the commonest cause of HIV-related hospital admissions to the Queen Elizabeth Hospital in Barbados. The medical records and available chest X-rays of 225 patients with LRT1 on their first admission during the period 1989-1995 were reviewed. The mortality among the patients was 26 percent and did not vary over the period under study. The radiologist's report on the CXR film was present in the records of 122 patients and eighty-six (70 percent) were reported as showing bilateral interstitial infiltrates. Twenty-one out of 28 (75 percent) deaths occurred in patients with bilateral interstitial infiltrates treated with the recommended dose of co-trimoxazole for Pneumocystis carinii pneumonia (PCP). Review of CXR films for nine patients with proven PCP confirmed that all had a "classical PCP" on CXR (i.e., bilateral mid-zone / diffuse fine reticulonadular or "ground glass" appearances). However, five of 11 patients with proven bacterial LRT1 (5 coliforms, 3 S.aureus, and 3 Pseudomonas sp.) also had "classical PCP" on CXR. We conclude that the high mortality may relate in part to the treatment of bacterial LRT1 with high dose co-trimoxazole. Empirical treatment should begin with gentamicin and ampicillin, with a switch to high-dose co-trimoxazole if patients fail to improve (AU)

The Barbados AIDS audit: a profile of first neurological admissions

Conditions affecting the CNS are the commonest cause of HIV-related death at the Queen Elizabeth Hospital. The medical records were reviewed for 185 HIV-positive patients on their first admission for a neurological problem (covering the period 1994-1995). Mortality was 70 percent and did not change overtime. Mortality was highest (81 percent) when no firm diagnosis was reached but was still high (45 percent) in the 77 cases where a CT and/or LP confirmed the diagnosis. The commonest confirmed diagnoses were cerebral toxoplasmosis (20 deaths out of 50 first admissions) and crytococcal meningitis (7 deaths out of 16 admissions). Currently, the favoured diagnostic strategy for neurological presentations is to obtain a CT and then do LP. Due to the apparent relationship between a CT and mortality in our population this strategy needs to be reconsidered. The presence of symptoms and/or signs of lower respiratory tract infection in a patient with no focal deficit appears to have a high predictive value for cryptococcal meningitis. An appropriate management strategy of neurological presentations in our setting may be to perform LP on admission in such patients with all others treated empirically for cerebral toxoplasmosis. We will prospectively evaluate this algorithm (AU)

Further findings of the Barbados AIDS audit - abstract

An audit was conducted of the notes of 162 patients with HIV infection who were alive on July 31, 1993. The length of hospital admissions, pattern of diagnoses, results of routine serological testing and quality of history taking were examined. Sixty-two (38 percent) of patients had been admitted to hospital. There was a trend toward shorter admissions over time: mean length of admission was 12.4 days in 1992 and 9.3 in 1993. Thirty-seven percent (37 percent) of the discharge diagnoses were respiratory and 30 percent were defining AIDS diagnoses. The most common diagnosis was PCP (18 diagnoses) followed by pneumonia due to proven or suspected bacterial infection (17 diagnoses). AL1 patients had serological evidence of past exposure to Herpes simplex I/II. Seventy-three per cent of patients had serological evidence of past exposure to toxoplasma, with 50 per cent of all patients having high titres. Thirty-one per cent of patients had positive syphilis serology but only 7 per cent of all patients had a VDRL titre of 1/8 or higher. Eleven per cent were positive for HTLV-1, 1.4 per cent for HBV sAg, and 99 per cent for IgG antibody to CMV. The audit of history taking demonstrated the need for a more careful history of presenting complaint as well as a more thorough past medical history. In summary, the audit continues to provide useful information to guide future clinical care (AU)

The Barbados AIDS audit - abstract

An audit was conducted of the notes of 156 patients with Human Immunodeficiency Virus (HIV) infection, who were alive on the 31st July 1993 and 45 patients who had died of HIV disease. All patients had been admitted to the Queen Elizabeth Hospital, Barbados, or had been seen in the counselling clinic which is located in the hospital. The purpose of the study was to evaluate the demographic and risk factor profile of the patients, to examine the pattern of HIV disease and to document the workload and demand on the counselling clinic which the patients attended. The use of various investigations was analyzed. Important findings were: 1. Women admitting to prostitution had a history of cocaine use; 2. Older men were morel likely to give a history of contact with prostitutes; 3. Sixty-two per cent of attenders at the clinic were in the early stages of HIV infection. These patients can be given less frequent follow-up appointments. 4. Respiratory tract infections were the major cause of hospital admission. 5. Neurological problems were the chief cause of death (AU)

Prevalence of HIV infection in STD clinic attenders in Barbados - abstract

In October 1987, an HIV counselling and testing study was initiated at Barbados' principal STD Clinic. The aim of the study was to determine the asymptomatic HIV carriage rate in a potentially high-risk population. Sequentially selected patients were counselled, and those agreeing to the HIV test were screened for antibodies, using Karpas AIDS test and the Abbott Recombinant ELISA test. Seropositive results were confirmed by Western Blot at CAREC. One hundred and eighteen males and eighty females were counselled. One hundred and eight males agreed to be tested and six (5.5 percent) were positve. Seventy-six females accepted the test and one (1.3 percent) was positive. The Karpas AIDS test as a screening test correlates satisfactorily with the Abbot ELISA. Of the seropositive patients for whom information is available, five of five males admitted to sex with prostitutes, three of five patients claimed sexual contact with tourists and five of five males admitted to sex with prostitutes, three of five patients claimed sexual contact with tourists and five of six had had a positive VDRL test for syphilis in the previous five years. The females was a prostitute and one of the positive males was bisexual. This male and one other positive male had received a blood transfusion in the previous five years. In this study population, HIV infection appears to be predominantly heterosexually acquired and particularly associated with sexual contact with prostitutes. A possible association between HIV infection sex with tourist needs further study (AU)

Abnormal thyroid hormone and thyrotropin levels in homozygous sickle cell disease

Male patients with SS disease had significantly lower T3 and higher TSH levels than a comparison group. Stimulation with TRH in 10 male sibling pairs showed highly significant increases in T3 and TSH in both patients and sibling controls although the increase in TSH was significantly greater in SS disease. The interpretation of these findings unclear although the thyroid indices indicate an abnormal pituitary-thyroid axis most consistent with a modest primary thyroid failure