Mycobacteria in HIV-infected patients in Buenos Aires

SETTING

F. J. Muñiz Hospital and Department of Phthisiopneumonology, in Buenos Aires.

OBJECTIVE

To analyze bacteriological findings concerning tuberculosis and other mycobacteriosis, in association with HIV infection and AIDS.

DESIGN

From June 1985 to December 1991, 2521 samples from 1259 HIV-seropositive and AIDS patients were analyzed: 1133 samples were of bronchopulmonary origin and the remaining 1388 of extrapulmonary origin. Drug susceptibility tests were performed using the proportions method.

RESULTS

Mycobacterial disease was confirmed by culture in 240 of the 1259 HIV/AIDS patients (19%). Mycobacterium tuberculosis was isolated in 223 of these cases (92.9%) and M. bovis in two, while M. avium-complex (MAC) strains were identified as the cause of disease in 14 patients (5.8%). In only one case was disease due to M. kansasii. Blood cultures were positive in 21.2% of these 240 cases. Resistance of M. tuberculosis to antituberculosis drugs was found in 9.4% of the 223 isolates. In only one case was multidrug resistance detected, in a patient who had received previous treatment.

CONCLUSION

Smear examination, although less sensitive than in HIV-negative patients, was still a simple and reliable tool for the rapid diagnosis of mycobacterial disease. Blood culture aided in the successful diagnosis of about half of the cases of disseminated tuberculosis and of all cases of MAC disease. An alarming spread of tuberculosis was detected among a group of HIV-positive prisoners, and the possible emergence of multidrug resistance should be anticipated.

The epidemiology of HIV infection and AIDS in Africa

Only 10 years after it was first recognized in Africa, HIV infection is already the leading cause of adult death in many cities of the continent and has increased childhood mortality. This article reviews critical aspects of the dynamics of this epidemic, including routes of transmission, factors influencing the rate of transmission and strategies to combat this disaster.

The relationship of substance use with sex to the use of condoms among young adults in two urban areas of Scotland

The relationship of the use of alcohol or drugs in conjunction with sexual activity and the use of condoms and other contraceptives was examined among 1378 respondents in a household survey of two urban areas of Scotland. In bivariate analyses, respondents who reported having had sex under the influence of alcohol or drugs were no less likely than respondents with no such experience to report consistent use of condoms, and having had sex under the influence of substances was positively related to lifetime condom use. Multivariate analyses that included gender and urban area as predictors yielded similar findings. The results suggest that individuals who combine sex with alcohol or drugs are not necessarily more likely to engage in riskier sex.

The impact of a lecture on AIDS on knowledge, attitudes and beliefs of male school-age adolescents in the Asir Region of southwestern Saudi Arabia

The aim of this study was to assess the levels of knowledge, attitudes and beliefs and AIDS among secondary school students in the Asir Region of Southwestern Saudi Arabia, and to assess the impact of a one-session AIDS education lecture given in some schools in the region during World AIDS Day, December 1992. An Arabic version of a previously reported self-administered questionnaire including factual and attitudinal items about AIDS was constructed. The questionnaire was given to two randomly selected groups of students; an experimental group of 335 students who had been exposed to a one-session lecture program about AIDS, and a control group of 503 students not previously exposed to the lecture. The results showed marked variability in correct responses to various specific items within and between groups. However, overall, 65% of the experimental group and 63% of the control group gave correct responses (P=0.517). Both groups were particularly less aware that casual contact cannot spread AIDS. However, fear of getting AIDS was significantly less among the experimental than among the control group (47% versus 58%, P = 0.011). Student knowledge about AIDS is inadequate, and the impact of an isolated one-session AIDS education lecture is less than satisfactory. AIDS education through a comprehensive school health program is recommended.

International aspects of the AIDS/HIV epidemic

This review provides the reader with pertinent information on the epidemiology, prevention, and new technologies of the ongoing HIV pandemic. These aspects are key to international policy discussions surrounding the public health response to the international spread of HIV. Our understanding of the impact of AIDS on other diseases is evolving, as is our insight into the demographic and economic effects of the epidemic on the global community. Observations on the success of certain prevention strategies allow rational allocation of resources in newly affected epidemic areas. Information on the origin and nature of HIV transmission exemplifies the phenomenon of global emerging infections. As world populations are brought closer together through transportation, communication, trade, and commerce, insight into emerging infections of epidemic potential becomes increasingly important to the practitioner of public health. Although important, legal and social aspects of the epidemic will not be emphasized here. The epidemics of HIV/AIDS in the United States and Europe are not reviewed here. The global pandemic has recently been described in an overview in this publication to which the reader is also referred.

Predictors of AIDS knowledge, condom use and high-risk sexual behaviour among women in Dar-es-Salaam, Tanzania

Reducing the number of sex partners and using condoms are the major means for individuals to protect themselves from STDs and AIDS in sub-Saharan Africa. To identify predictors of having only one sex partner in the last year and to assess knowledge and use of condoms among women of reproductive age in Dar-es-Salaam, Tanzania, we interviewed 2285 women at 3 representative family planning clinics between February 1991 and June 1992. After interview, blood and genital specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). Although knowledge of sexual transmission of AIDS was very high, less than a half of the respondents (42.8%) mentioned use of condoms as an AIDS preventive measure. Younger and more educated women were more likely to mention use of condoms for AIDS prevention, however only 4.6% of women interviewed were regular users of condoms, while 19.8% were occasional users. The majority of women who had never used a condom (57.5%) reported not using condoms because 'men did not like them'. Condom use was positively associated with increasing level of education and increasing number of sexual partners. 14.8% of women reported having more than one sex partner in the last year; this behaviour was more likely among cohabiting women (increased by 210%); HIV-positives (increased by 120%); and among women with STDs (increased by 50%).(ABSTRACT TRUNCATED AT 250 WORDS)

Screening for active tuberculosis in HIV testing centre

In industrialised nations HIV-seropositive individuals can be offered skin testing for tuberculosis (TB) and isoniazid prophylaxis, but this approach is neither practicable nor affordable in most developing countries. In Santo Domingo, Dominican Republic, we offered skin testing and a brief clinical examination for active TB to people requesting HIV testing at one centre. 200 newly detected HIV-positive individuals and 200 age and sex-matched HIV-negative ones were compared. 39 (9.7%) of the 400 individuals seeking HIV testing had active TB; 29 were HIV positive and 10 were HIV negative (adjusted odds ratio 3.3, 95% CI 1.3-8.7; p = 0.01). In multivariate analysis, the strongest independent predictors of active TB were 10 mm or more of induration on skin testing, a history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. Screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among not just HIV-positive but also HIV-negative people. Integrating screening for TB into HIV testing schemes could help to reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.

Pathological lesions in HIV positive patients

Pathomorphological features of 10 HIV positive individuals studied at autopsy and biopsy are described. Nine patients had evidence of neuro-AIDS and eight of them succumbed to various opportunistic infections. One surviving patient underwent a diagnostic lymph node biopsy which revealed tuberculous lymphadenopathy. Cryptococcal meningitis was the commonest CNS opportunistic infection, seen in five cases, with disseminated systemic cryptococcosis in two. The other opportunistic infections included toxoplasma encephalitis in two, with acanthamoeba infection in one patient. Pulmonary tuberculosis was noted in three patients while other bacterial infections such as meningococcal meningitis, pseudomonas septicaemia were observed in three and pneumocystis carinii pneumonia in one. One seropositive individual was clinically asymptomatic but succumbed to a road traffic accident. The brain in this case showed features of HIV associated early leucoencephalopathy. Bacterial infections caused by organisms other than Mycobacterium tuberculosis associated with AIDS are often underdiagnosed and should be considered, especially in developing countries. In cases of cryptococcal and tuberculous meningitis or multiple parasitic infections, the patients should be screened for associated HIV infection.

Immune activation is a dominant factor in the pathogenesis of African AIDS

The AIDS epidemic in Africa is very different from the epidemic in the West. As suggested here by Zvi Bentwich, Alexander Kalinkovich and Ziva Weisman, this appears to be primarily a consequence of the over-activation of the immune system in the African population, owing to the extremely high prevalence of infections, particularly helminthic, in Africa. Such activation shifts the cytokine balance towards a T helper 0/2 (Th0/2)-type response, which makes the host more susceptible to infection with human immunodeficiency virus (HIV) and less able to cope with it.

The human immunodeficiency virus epidemic in India. Current magnitude and future projections

Since the first case of the human immunodeficiency virus (HIV) infection was documented in India in 1986, there has been an explosive increase in HIV transmission. In this review we describe the chronology of the HIV epidemic in India, preliminary information about the clinical presentation of the acquired immunodeficiency syndrome (AIDS), the biological and behavioral aspects of HIV transmission in the Indian setting, and projections regarding the future of the HIV epidemic in India. Using recent data obtained by searching the computerized literature and published abstracts, conference proceedings, and publications from the government of India, we show that India is experiencing a major epidemic of HIV transmission in high-risk populations of commercial sex workers, sexually transmitted disease clinic patients, intravenous drug users, and commercial blood donors. There is also evidence of recent spread of the epidemic from these high-risk groups to other risk groups in India, and from urban centers to rural populations. It is estimated that 1.6 million people are currently infected with HIV in India. At the present rate of transmission, India will have the largest number of HIV-infected individuals of any country in the world by the end of this decade, with more than 5 million infected individuals. Because limited data are available, comprehensive and well-designed epidemiologic surveys are urgently needed to adequately characterize the HIV epidemic in India and to help implement targeted and effective educational and prevention-oriented programs.

Methods used to study household coping strategies in rural South West Uganda

This paper describes the data collection methods used in a longitudinal study of the coping strategies of 27 households in three villages in the study area of the MRC/ODA Research Programme on AIDS in Uganda. After pre-testing and piloting, 9 local interviewers made regular visits to the 27 study households over a period of just over one year. The households were purposively selected to represent different household types and socioeconomic status categories. Data were obtained through participant observation using a checklist to ensure systematic collection of data on household activities. Debriefing sessions with the interviewers after the visits provided opportunities for the discussion of the findings and exploration of themes for further study. On the basis of the study findings, and data from the Programme's general study population survey rounds, broad indicators of household 'vulnerability' were identified. A participatory appraisal technique, 'well-being ranking', was used at the end of the study in order to test the viability of the chosen indicators. It is proposed that the example of the research method, which relied on local people not only as interviewers but also as co-investigators in the research, be used to guide future research approaches. The participation of the study community at every stage of research and design, as well as monitoring and evaluation of supportive interventions, is strongly encouraged.