HIV Infection In Africa Research Articles

Circumcision and HIV infection: review of the literature and meta-analysis.

Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.

Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addicts and food poisoning: research on the influence of aflatoxins on child health in the tropics.

Similarities between the geographical and climatic prevalences of kwashiorkor and of exposure to dietary aflatoxins, and between the biochemical, metabolic and immunological derangements in kwashiorkor and those in animals exposed to aflatoxins, prompted investigation of the associations between kwashiorkor and aflatoxins. Studies in Africa in the 1980s indicated a role for these toxins in the pathogenesis of the disease. Paediatric cases of kwashiorkor are less prone to severe Plasmodium falciparum malaria than normal children. In mice infected with P. berghei, aflatoxin exposure inhibits parasite growth and ameliorates morbidity. Aflatoxins occur in < or = 40% of samples of breast milk from tropical Africa, usually as low concentrations of the relatively non-toxic derivatives of aflatoxin B1 (AFB1) but sometimes as high concentrations of the very toxic AFB1. This could explain kwashiorkor in breast-fed babies. Aflatoxin exposure occurs in > or = 30% of pregnancies in tropical Africa and the toxins are often in cord blood, sometimes at extremely high concentrations. Aflatoxins are now incriminated in neonatal jaundice and there is circumstantial evidence that they cause perinatal death and reduced birthweight. Aflatoxin-induced immunosuppresion may explain the aggressive behaviour of HIV infection in Africa. There are similarities between observations on HIV cases in Africa and those on heroin addicts in Europe, where 'street' heroin is frequently contaminated with aflatoxin. Aflatoxins were found in 20% of random urine samples from heroin addicts in the U.K. and the Netherlands. Aflatoxins have also been incriminated in episodes of food poisoning which have been associated with serious morbidity and mortality, particularly among young children.

S072 Genital ulceration and HIV infection in Africa

S072 Genital ulceration and HIV infection in Africa

The Neuropathology of HIV-infected African Children in Abidjan, Côte dʼlvoire

In an autopsy study of HIV-infected children in Abidjan, Côte d'Ivoire, the neuropathology of 76 HIV-1- and 2 HIV-2-positive children was compared with that of 77 frequency-matched HIV-negative children, in whom the systemic pathology was also known. Seventy of the 78 HIV-seropositive children were confirmed as HIV-infected, as determined by combined serology, IgA Western blots and clinicopathological criteria. The HIV-negative children showed a high background level (n = 49, 64%) of neuropathological abnormalities, including nonspecific inflammatory infiltrates, micromineralization, and bacterial and lymphocytic meningitis. In the HIV-positive children, HIV encephalitis was found in 4 (6%), cytomegalovirus in 2 (3%), toxoplasmosis in 3 (4%) and measles encephalitis in one (1%). Bacterial meningitis was equally common in both groups, but cerebral malaria was less common (n = 2, 3%) in HIV-positive than in HIV-negative children (n = 11, 14%). The low prevalence of HIV encephalitis may reflect comparatively early death in HIV infection in Africa as compared with our experience in Europe and the US.

One New Humanity: the Challenge of AIDS

Anne Bayley SPCK, £9.99, pp 330 ISBN 0 281 04923 8 “How does a society with a history of violence, buckling under the pressure of poverty and land scarcity, react to the news that an unknown third of its members carry the virus?” In Rwanda, with a population prevalence of HIV among the highest in the world, a survey in 1992 in a military camp found that 70% of the soldiers were more afraid of HIV and AIDS than of being at war. The cumulative incidence of HIV infections in Africa (over 11 million) and increasingly in Asia (over 3 million) is far …

Notes on the socio-economic and cultural factors influencing the transmission of HIV in Botswana

Botswana currently has one of the highest recorded incidences of HIV infection in Africa although AIDS was only first publicly recognized in 1985. By this time other countries in the region such as Malawi, Zambia and Uganda were already showing signs of epidemic levels of HIV. The rapid transmission of HIV in Botswana has been due to three main factors; the position of women in society, particularly their lack of power in negotiating sexual relationships: cultural attitudes to fertility; and social migration patterns. These three factors along with other, arguably more minor, ones have been shaped and mediated within the specific context of Botswana's rapid socio-economic development and cultural milieu. This has resulted in a constellation of factors unique to Botswana which accounts for the current high seroprevalence rate in the country.

AIDS: the view from Africa

Epidemiological data on AIDS in several zones in Africa is presented. The clinical and diagnostic aspects of HIV infection in Africa, based on the definition of Bangui's AIDS (1986), are analysed and the criteria is presented. The treatment and follow-up of a patient with infusion by HIV in the African context is discussed. Reference is then made to some data on the status of AIDS in Angola.

Identification of HIV-1 Subtype G from Uganda

HIV-1 subtype G was identified by the authors in the former Soviet Union, and is related to a sequence VI525 from Gabon. All told, subtype G isolates have been identified in the former Soviet Union, Gabon, Zaire, and Nigeria. A subtype G gag sequence has also been reported in Taiwan. This paper reports the first HIV-1 subtype G to be isolated from Uganda. Uganda has the highest reported incidence of HIV-1 infection in Africa, with HIV-1 subtypes A, B, C, and D having already been isolated in the country. The authors isolated and sequenced HIV-1 genetic subtype G from a Ugandan female patient with CDC stage IV disease and a CD4 count of 20/cu. mm. Although recently immigrated to the UK from Uganda, there is epidemiologic evidence that the patient was infected with HIV-1 in Uganda. The V3 region of the isolate had 35 amino acids, with the common African tetrapeptide GPGQ at the tip of the loop. There were deletions relative to other G subtype sequences in the V4 and V5 env regions. The phylogenetic relationship of UGJW3 with other HIV-1 strains was inferred using nucleotide sequences and the PHYLIP package. The C2-V5 env region of the isolate was found to cluster with the subtype G isolates from the former Soviet Union and the Gabon. These findings confirm the need for further examination of the distribution of HIV-1 genetic subtypes and the exploration of their biologic significance.

Seroprevalence of of Human lmmunodeficiency Virus Type-1 Infection in Africa

The epidemiological characteristics of HIV-1 infection in Africa have gradually been elucidated through various studies. The HIV-1 infection is believed to have existed in the 1960s in Africa and is presently epidemic in Africa. The HIV-I seropositive rate for the general population is higher in urban regions than in rural areas. The peak age of males infected with the HIV-1 tends to be higher than that of females infected with the HIV-1 Sex difference is recognized in the HIV-1 serpopositive rates. Heterosexual contact, mother-to-child transmission and contaminated blood transfusion are confirmed as the modes of HIV-1transmission. Prostitutes and STD patients are recognized as being high-risk groups for the HIV-1 infection. Where HIV-1 infection is widely distributed in the general population, risk reduction strategies should place strong emphasis on safe-sex techniques in addition to the promotion of partner reduction. J Epidemiol, 1995; 5 : 1-9.

Kaposi's sarcoma in HIV infected women in Germany: more evidence for sexual transmission. A report of 10 cases and review of the literature.

To assess the natural history of Kaposi's sarcoma (KS) in HIV-positive women living in Germany. All physicians reporting the diagnosis of KS in a female patient were contacted and asked for detailed information. Descriptive study of clinical, epidemiological and immunological data of ten women with biopsy-proven KS living in Germany were evaluated. The results are compared with those of other previously published studies of women with KS from Italy, France and the USA. Five centres in Germany. Of 765 German women with AIDS, only 10 (1.3%) were reported to suffer from Kaposi's sarcoma (KS) compared with 1771 of 8128 men (21.8%). Mean age in these women was 39.7 years. KS was the first AIDS defining event in nine women and the reason for HIV-testing in three. The mean CD4 count was 215/microliters. Two patients were of African origin, had only recently come to Germany and were most likely to have acquired their HIV-infection in Africa. Three patients were i.v.-drug users (IVDU). Two of these (and most likely all three) had worked as prostitutes. Of five women who had contracted HIV via heterosexual contacts, one worked as a prostitute and the other four were married to or were living together with a bisexual HIV-positive man. All four male partners have also developed KS. The course of the disease seems to be particularly aggressive in female patients with eight of 10 women presenting with or progressing to widely disseminated disease with extensive involvement of internal organs. In this cohort survival was longer in females who acquired their HIV infection heterosexually compared to IVDU and was strongly correlated with higher CD4-counts at diagnosis. KS seems to run a particularly aggressive course in women. Our data are consistent with a sexually transmittable aetiological agent of KS. Prostitution, an issue yet to be addressed by other authors reporting series of women with KS, was reported in four of our patients. Further studies are needed to clarify the significance of this finding.

Les inegalites geographiques de l'infection a vih et du sida en Afrique sud-saharienne

The geography of HIV infection in Africa (which is the continent with the highest incidence rates) has varied features at each scale. The transmission is oriented preferentially according to axes and poles where the virus--because of local environmental factors--found favorable conditions to dissemination and spread. The dynamic of the epidemic results from factors related to sociologic, cultural, religious behaviour and to geographical, political and economic situations. The local combination of all the causal factors explains the complexity and diversity of the geographic characteristics of the African epidemic. The knowledge of the complexity and diversity of the geographic characteristics of the African epidemic. The knowledge of the causal factors calls upon various disciplines. Spatial networks, population movements and their consequences are analyzed. Geographical data together with sero-epidemiologic information initiate hypothesises related to the spatial dynamic of the epidemic and to the processes of regionalization.

Clinical and laboratory predictors of survival in Gambian patients with symptomatic HIV-1 or HIV-2 infection.

To determine which clinical and immunological features of patients with symptomatic HIV-1 and HIV-2 infection best predict survival in The Gambia. All patients presenting to two hospitals in The Gambia between January 1987 and June 1990 with symptoms or signs suggesting chronic HIV infection were tested for HIV-1 and HIV-2 antibodies. Eighteen HIV-1 and 31 HIV-2-infected patients were recruited to the study, investigated intensively on admission and followed up until the end of 1990. Presenting clinical features, such as Karnofsky score, diagnosis of AIDS according to World Health Organization Bangui or Centers for Disease Control criteria and number of associated infections, together with five immunological measurements, as well as type of HIV infection, were related to length of survival using proportional hazard models fitted to Kaplan-Meier plots of survival times. Karnofsky score and diagnosis of AIDS were the best clinical predictors of survival. Type of HIV infection or number of associated infections did not predict outcome. The most powerful laboratory predictors were log(e) serum neopterin level, CD4 cell count and log(e) serum beta 2-microglobulin (beta 2M) level. The estimated median survival times (90% confidence interval) of the HIV-1 and HIV-2-infected were six (4-11) and 13 (9-20) months, respectively. These survival times do not differ significantly. The Karnofsky score and measurements of serum neopterin or beta 2M, which are easier and cheaper to perform than CD4 counts, may prove to be useful guides to prognosis for HIV infection in Africa.

Herpes Zoster as an Indicator of HIV Infection in Africa

In areas where resources for health information are limited, the incidence of herpes zoster can usefully be monitored as an indicator of HIV infection. A sudden parallel rise of the number of symptomatic HIV cases and herpes zoster cases was observed in a northern district of Zimbabwe. Herpes zoster was made locally reportable. Three years later the incidence of herpes zoster and HIV in the hospital and of herpes zoster in the surrounding rural health centres was analysed. The herpes zoster attack rate and the HIV seropositivity rate of herpes zoster patients resembled those elsewhere in Africa. The distribution of cases of zoster was comparable with that of HIV infection.

HIV infection in Africa

AIDS in Africa. Edited by Peter Piot Bila Kapita and JBO Were. Current Science: 1991. Pp. 209. £35, $59 and (pbk). Aids in Africa: Its Present and Future Impact. By Tony Barnett Piers Blaikie. Belhaven: 1992. Pp. 193. £35 (hbk), £9.99 (pbk).

AIDS and HIV infection in Uganda—are more women infected than men?

In countries in sub-Saharan Africa, HIV is transmitted primarily heterosexually. HIV infection and AIDS in women not only affects women's health but also has implications for the other members of society. Maternal infection is the source of most childhood HIV infection in Africa and maternal health is a strong predictor of child survival. In Uganda, a review of passive AIDS surveillance has shown almost equal numbers of clinical cases reported in men and women. However, in three population-based HIV serosurveys, women were consistently found to have a higher infection rate (approximately 1.4 times) than men. In addition, both AIDS case surveillance and seroprevalence studies demonstrate an earlier age of presentation and mean age of infection in women. The higher rate of HIV infection in women suggests either differential rates of transmission between women and men, higher rates of female sexual exposure to infected men, or longer survival among HIV-infected women compared with men. Although further studies are required to illuminate both the biology and the epidemiology of heterosexual HIV transmission in Africa, these findings of earlier and higher infection rates in women have important implications for women's health and child survival in Uganda and indicate the need for specially targeted interventions to reduce transmission in this group.

Human herpesvirus type 6 and HIV infection in Africa

Human herpesvirus type 6 and HIV infection in Africa

Transition dynamics of HIV disease in a cohort of African prostitutes

The progression of HIV-related disease from infection to death is represented as a staged Markov model. Transitions between stages are considered reversible. The model is fitted to data from a cohort of African prostitutes by means of maximum likelihood. It appears that the progression to symptomatic disease (Centers for Disease Control stage IV) in this population is considerably more rapid than that reported from studies in Western countries.

HIV infection in Africa.

HIV infection in Africa.

Tuberculosis and HIV infection in Africa.

<h3>BACKGROUND:</h3> COPD guidelines report that systemic corticosteroids are preferred over inhaled corticosteroids in the treatment of exacerbations, but the inhaled route is considered to be an option. <h3>OBJECTIVES:</h3> To conduct a systematic review and meta-analysis regarding the efficacy and safety of inhaled corticosteroids for COPD exacerbations. The second objective was to provide pharmacologic and clinical perspectives of inhaled corticosteroids for COPD exacerbations. <h3>METHODS:</h3> The primary outcome was a change in FEV₁ baseline versus the last measured value. Secondary outcomes were a change in (P_aO₂) and (P_aCO₂) baselines versus the last measured values; FEV₁, P_aO₂, and P_aCO₂ at 24 or 72 h; and hyperglycemia. <h3>RESULTS:</h3> Each of the 9 studies included in the meta-analysis was conducted in subjects who were hospitalized and not critically ill. Our meta-analysis indicated that high-dose nebulized budesonide 4–8 mg/d was noninferior to systemic corticosteroids on the change in FEV₁ between baseline and the last measured value (mean difference of 0.05, 95% CI −0.01 to 0.12, <i>P</i> = .13) and P_aCO₂ (mean difference of −1.14, 95% CI −2.56 to 0.27, <i>P</i> = .11) but of inferior efficacy for P_aO₂ changes (mean difference of −1.46, 95% −2.75 to −0.16, <i>P</i> = .03). Hyperglycemia was less frequent with high-dose nebulized budesonide (risk ratio, 0.13; 95% CI 0.03–0.46; <i>P</i> = .002). <h3>CONCLUSIONS:</h3> Based on our meta-analysis with a change in FEV₁ as the primary end point, high-dose nebulized budesonide was an acceptable alternative to systemic corticosteroids in hospitalized subjects with COPD exacerbations who were not critically ill. Additional well-designed prospective studies are needed in both the acute care and ambulatory settings. We provide perspective on how this evidence might be applied in clinical practice.

Genomic Diversity of Zairian HIV Isolates: Biological Characteristics and Clinical Manifestation of HIV Infection

We describe here several African isolates of HIV, compare them to U.S.-European prototype isolates and to each other, correlate the number of isolates with serological results, and provide insights into the disease spectrum associated with HIV infection in Africa. Three of 25 healthy Zairian donors and 54 of 87 Zairian patients selected for specific pathology and hospitalized in the internal medicine department of the University Clinic of Kinshasa, Zaire, were HIV positive over a six month period in 1985 either by serum antibody (42 cases) or virus isolation (40 cases). The virus positive cases showed a decrease in number of T4 cells and interleukin-2 (IL2) production by mononuclear cells. Restriction endonuclease analysis of HIV sequences from these isolates showed that genomic diversity is also observed in the Zairian isolates but closely related viruses could also be found, similar to the spectrum of diversity among isolates obtained from the U.S. and Europe. A number of isolates (12 of 40) were obtained from serum antibody negative adults. These results are difficult to explain by viral antigenic diversity alone since hybridization with a HTLV-III-B (clone BH10) probe under stringent conditions indicated an overall high degree of relatedness. Rather, these results indicate that some African HIV infected patients fail to make detectable antibodies to HIV or the antibodies were bound in immune complexes not detectable by current techniques.