Type-specific herpes simplex virus-1 and herpes simplex virus-2 seroprevalence in Romania: comparison of prevalence and risk factors in women and men

OBJECTIVE

To determine herpes simplex virus (HSV)-2 and HSV-1 seroprevalence in women and men in Romania.

METHODS

A cross-sectional seroprevalence survey was conducted between 2004 and 2005 on a total of 1058 women and men representative of the population of Bucharest. All participants were aged 15-44 years and completed a structured questionnaire. A blood sample was collected to detect IgG anti-HSV-1 and HSV-2 serum antibodies using the HerpeSelect ELISA (Focus Diagnostics).

RESULTS

A total of 761 women (median age 29 years) and 297 men (median age 29 years) were included. Overall, HSV-2 seroprevalence (15.2%) increased with age. Among women, HSV-2 seroprevalence increased from 11.0% in 15-19-year-olds to 38.3% in 40-44-year-olds. Among men, seroprevalence increased from 4.0% in 20-24-year-olds to 27.1% in 40-44-year-olds. HSV-2 seroprevalence was significantly higher among women than men (17.0% vs. 10.8%). HSV-1 seropositivity was high (87.2%) in all age groups, with no clear trend by age or by sex. In addition to older age and female sex, risk factors for HSV-2 included greater number of lifetime sexual partners, lower educational attainment, and history of genital vesicles. Lower educational level and rural residence were associated with a higher risk of HSV-1 seropositivity.

CONCLUSIONS

In Romania, HSV-2 seroprevalence was higher in women than men, and was within European limits and lower than that in Africa and the USA. In contrast, HSV-1 seroprevalence was generally higher than that previously recorded in similarly aged populations in Western Europe.

[Use of antiretroviral drugs invoices for the follow-up of a treatment programme. Example in Abidjan, Côte d'Ivoire]

A retrospective analysis of the prescriptions of the ARV treatment programme in Abidjan, Côte-d'Ivoire enabled the authors to assess the collected anonymous information in order to evaluate the efficacy of the programme. This collection of information helps to supervise each center at a lower cost, to alert on some working problems and to follow the quality of the observance. This supervision is possible regardless of the health care places, it can be carried out systematically from the administrative or financial services. In this study this follow-up reveals some problems.

Triple Nucleoside Combination Zidovudine/Lamivudine/Abacavir versus Zidovudine/Lamivudine/Nelfinavir as First-Line Therapy in HIV-1-Infected Adults: A Randomized Trial

Objective

To compare the efficacy and safety of a triple nucleoside combination to a protease inhibitor-containing triple regimen as first-line antiretroviral therapy (ART) in HIV-1-infected patients.

Design

Open-label study in HIV-1-infected ART-naive adults, randomized to receive either Combivir® (lamivudine 150 mg/zidovudine 300 mg twice daily) + abacavir (300 mg twice daily), or Combivir® + nelfinavir (750 mg every 8 h) for 48 weeks. Plasma HIV-1 RNA, CD4 cell count and adverse events were assessed at baseline and weeks 4, 8, 16, 24, 32, 40 and 48.

Results

195 subjects (131 men, 64 women), median age 34 years, were randomized: 98 received combivir/abacavir and 97 combivir/nelfinavir. Baseline median plasma HIV-1 RNA was 4.2 log10 copies/ml [Interquartile range (IQR): 3.7-4.5.2] and 4.1 log10 copies/ml (IQR: 3.8–4.6), respectively. Baseline median CD4 cell count was 387 cells/mm3 (IQR: 194–501) and 449 cells/mm3 (IQR: 334–605), respectively. Nine patients (3 vs 6, respectively) did not start treatment or did not have any available efficacy data. At week 48, using the intent to treat analysis (switch/missing equals failure), plasma HIV-1 RNA was <50 copies/ml in 54/95 (57%) and 53/91 (58%) of subjects, respectively. Median CD4 increase was +110 and +120 cells/mm3, respectively. Possible hypersensitivity reactions to abacavir were reported in four subjects (4%).

Conclusion

The triple nucleoside combination combivir/abacavir is well tolerated as a first-line ART regimen in HIV-1-infected adults, with comparable antiviral activity to a nelfinavir-containing regimen at week 48.

[Antiretroviral drugs for the treatment and prevention of herpes infections in the year 2000]

Major developments in the two last decades have improved the diagnosis and the treatment of Herpes Simplex Virus infection. Aciclovir was the first effective antiherpetic drug available. Afterwards other drugs have been developed either with a better bioavailability or with an activity against aciclovir-resistant strains. Although there is at present no effective vaccine or drug capable of eradicating established infection, these antiviral drugs are able to shorten the course and decrease severity of symptomatic episodes in both normal and immunocompromised patients. Moreover in patients with frequently recurrent herpes a suppressive therapy will suppress episodes or decrease their frequency. The ongoing therapeutic research, beside the development of new drugs inhibiting viral replication, concerns the strengthening of specific immune response which should lead to the development of effective therapeutic and preventive vaccines.

Seroprevalence of HSV-1 and HSV-2 infection in the general French population

BACKGROUND

In spite of the large prevalence and growing incidence of herpes simplex infection (HSV-1 and HSV-2), relatively few large serological surveys are available worldwide and it is still difficult compare frequencies of HSV contaminations in various countries. We present the results of HERPIMAX, the first epidemiological inquiry on HSV prevalence in the general French population.

METHODS

Of a cohort of 12,735 presumed healthy adult volunteers included in the prospective study SU.VI.MAX, designed to assess the relation between nutritional supplementations and degenerative diseases, HERPIMAX randomly selected 4412 subjects (females 66.5%, males 33.5%). All serum samples were assessed for HSV-1 and HSV-2 IgG antibodies with a HSV type specific, enzyme immunosorbent assay (EIA). Equivocal result were retested with another HSV type specific immunoblot assay combined with a type common HSV IgG EIA in order to give a definitive interpretation.

RESULTS

The mean seroprevalence was 67% for HSV-1 and 17.2% for HSV-2. For HSV-2 the seroprevalence was higher in females (17.9%) compared with males (13.7%) (p<0.001). For both HSV types, there was no significant difference in prevalence as regards age distribution in males and females, whereas prevalence increased significantly with age in females for HSV-1. Univariate analysis showed a significant association between HSV-1 prevalence and education level in males and females (p<0.001) and between HSV-2 prevalence and marital status in both sexes (p<0.001). There were geographical disparities, with a higher HSV-2 prevalence in the south of France as well as in Paris.

CONCLUSION

These results confirm a high prevalence of HSV infection in France. They are also in agreement with previous results of other survey carried out in other developed countries as regards higher prevalence of HSV-2 infection in women, the stability of seroprevalence for both HSV types after 35 years of age in females and 45 years of age in males.

[Natural history of HSV1 and HSV2 transmission modes and epidemiology consequences of HSV infection on HIV infection. Prevention]

Both Herpes simplex viruses HSV1 and HSV2 are transmitted by direct mucosal or cutaneo-mucosal contact between individuals. HSV1 is the leading cause of orofacial herpes and HSV2 the most frequently encountered cause of genital herpes. There are however a number of environmental and behavioral factors that modify the epidemiological pattern in both infections. These factors also affect virus dynamics and spread. In developing countries, HSV1 infections continues to be acquired in early childhood. In developed countries, displacement of this acquisition towards adolescence and adulthood explains, in part, the increase in genital herpes caused by HSV1. HVS2 infection progresses in the sexually active population worldwide. Although the rate of seroprevalance varies greatly from one continent to another, women are still more often infected than men. HSV2 genital infection is a cofactor for transmission and acquisition of HIV, which, in certain African regions where the two infections are highly prevalent, explains in part the progression of the HIV epidemic. Until a vaccine becomes available, the prevention depends on abstention from all oral and genital contact during periods of active disease. For genital herpes, use of a preservative has only a relative protective effect and the contribution of suppressive treatment in potentially contaminated subjects is under evaluation.

Famciclovir vs. aciclovir in immunocompetent patients with recurrent genital herpes infections: a parallel-groups, randomized, double-blind clinical trial

BACKGROUND

Twice-daily therapy with famciclovir (FCV) was shown to be effective for episodic therapy for recurrent genital herpes in a large placebo-controlled trial. However, no study has been published to date comparing FCV and aciclovir (ACV).

OBJECTIVES

We have evaluated the effectiveness of FCV vs. ACV in the treatment of recurrent genital herpes infection.

METHODS

A multicentre, double-blind, double-placebo, randomized, parallel-design study, assessed for equivalence, was conducted. As the analysis was based on confidence intervals, a difference of lesion healing time between ACV and FCV (Delta) of 1.05 days with a standard deviation of 2.30 days was chosen. Two hundred and four outpatients were included. Patients self-initiated oral therapy with 125 mg of FCV twice daily or ACV 200 mg five times daily for 5 days. The principal end-point of the study was the complete healing of lesions. Duration of the complete resolution of all symptoms, and safety were also considered.

RESULTS

The mean healing time was 5.1 days and 5.4 days for FCV and ACV, respectively, with a crude value of Delta = 0.25 days (CI 95%: -0.32; 0.82) in the intent-to-treat population. Therefore, the confidence interval for the difference between the two treatments lies entirely within the equivalence range (-1.05-1.05). The value of Delta in the per-protocol population [0.35 day (CI 95%: -0.24; 0.93)] was comparable between the two groups. No differences were detected in the proportion of patients having complete healing at the different days of evaluation as well as in the duration until the complete resolution of all the symptoms. The frequency, nature and severity of adverse events did not differ among the two treatment groups.

CONCLUSIONS

Twice-daily FCV was as effective and safe in the treatment of recurrent genital herpes simplex virus infection as five times daily ACV.

In vitro inactivation of Chlamydia trachomatis and of a panel of DNA (HSV-2, CMV, adenovirus, BK virus) and RNA (RSV, enterovirus) viruses by the spermicide benzalkonium chloride

Kinetics of inactivation by the detergent spermicide benzalkonium chloride (BZK) of Chlamydia trachomatis and of a panel of DNA viruses [herpes simplex virus hominis type 2 (HSV-2), cytomegalovirus (CMV), adenovirus (ADV) and BK virus (BKV)] and RNA [respiratory syncytial virus (RSV) and enterovirus (ENV)] were established in accordance with a standardized in vitro protocol. After a 5 min incubation, inactivation of >95% of HSV-2 and CMV was obtained at a concentration of 0.0025% (w/v) (25 Ig/L); concentrations as low as 0.0005%, 0.0050% and 0.0125%, induced a 3.0 log10 reduction in infectivity of HSV-2 and CMV, RSV and ADV, respectively. After a 60 min incubation, concentrations of 0.0125% and 0.050% provided a 3.0 log10 reduction in infectivity of ENV and BKV, respectively. These features indicate that sensitivity to BZK was very high (HSV-2 and CMV) or high (RSV) for enveloped viruses, intermediate (ADV) or low (ENV and BKV) for non-enveloped viruses. Furthermore, BZK had marked antichlamydial activity, showing >99% killing after only a 1 min incubation at a concentration of 0.00125%. BZK demonstrates potent in vitro activity against the majority of microorganisms causing sexually transmitted infectious diseases, including those acting as major genital cofactors of human immunodeficiency virus transmission. These attributes qualify BZK as a particularly attractive candidate for microbicide development.

Selection of drug-resistant variants in the female genital tract of human immunodeficiency virus type 1-infected women receiving antiretroviral therapy

We investigated human immunodeficiency virus (HIV) type 1 RNA, proviral DNA, and antiretroviral drug-resistant variants in cervicovaginal secretions of HIV-1-infected women receiving antiretroviral therapy. The prevalence of detectable HIV-1 RNA in genital secretions was inversely related to the number of antiretroviral drugs taken by the patients. Proviral DNA was detected in approximately half of all samples of cervicovaginal secretions from HIV-1-infected women, regardless of the presence or absence of HIV-1 RNA in cervicovaginal secretions and of the antiretroviral regimen. In cervicovaginal secretions of most women with persisting genital viral replication, HIV variants exhibiting mutations associated with drug resistance against protease and reverse-transcriptase pol genes were found. Our observations indicate that antiretroviral therapy is not effective in purging the female genital tract of cell-associated provirus and that antiretroviral drugs that penetrate the female genital tract at suboptimal concentrations exert a potent selective pressure on genital HIV variants when local replication of free HIV-1 RNA persists.

[Agranulocytosis in acute hepatitis B in an HIV seropositive patient]

BACKGROUND

During the course of acute hepatitis B, hematology disorders are common though they are generally mild and occur early. Agranulocytosis is exceptional and occurs late in the disease course.

CASE REPORT

We report a case of agranulocytosis which developed 3 weeks after onset of acute hepatitis B in an HIV-positive patient. Peripheral and central hematological disorders led to the diagnosis. Agranulocytosis developed during the cytolytic phase of the primary hepatitis B infection and regressed after administration of hematopoietic growth factors.

DISCUSSION

It is sometimes difficult to establish the causal effect of hepatitis B in the development of agranulocytosis in patients with an HIV co-infection who are on a multiple drug regimen and subject to multiple bacterial, viral or parasite infections.

Quality of life and use of health care among people with genital herpes in France

In order to assess psychological morbidity in France related to genital herpes infection, we carried out a transversal study comparing infected patients with a control group. A total of 236 patients with genital herpes were first identified by means of a postal survey, then matched against a witness group of 236 noninfected persons. Detailed questionnaires were sent out to each person in the 2 groups. A total of 150 herpes patients and 200 non-infected persons answered the questionnaire, which enabled us to measure the incidence of the disease by means of 2 indicators: a herpes-specific scale and the SF-36 quality of life questionnaire. Emotional trauma due to genital herpes was reported amongst 23% of the participants. Of the participants, 57% indicated that herpes interfered with their sexual relationships; 50% felt it difficult to live with genital herpes; and 37% felt that herpes ruins their lives. An analysis assessing health-related quality of life indicated significant differences between the scores of the 2 groups and showed that quality of life is lower amongst herpes patients. Respondents with genital herpes required more frequent consultations with GPs (81% vs. 73%), and significantly more frequent consultations with specialists (59% vs. 45%). Our study confirms that substantial psychological morbidity exists in patients with genital herpes.

Epidemiology of genital herpes - recent advances

Genital herpes is a common, distressing infection which, due to increasing incidence world-wide, has become a prominent public health issue over recent years, even throughout the decade of human immunodeficiency virus (HIV). Since the late 1970's, the prevalence of herpes simplex virus type 2 (HSV-2) infection has increased by approximately 30 percent in the US. The number of sufferers world-wide is currently estimated at approximately 86 million people. New serological methods based on the detection of type-specific antibodies to herpes simplex virus (HSV) glycoproteins have clarified issues concerning the true incidence of genital herpes, the modifying effect of prior HSV-1 infections, the changing proportions of HSV-1 genital herpes, and the importance of asymptomatic shedding. Patients' ignorance of their diagnosis along with the occurrence of atypical symptomatology and asymptomatic viral shedding of HSV all contribute to the transmission of genital herpes. Genital ulcer disease, of which genital herpes is the most common cause in developed countries, is an important risk factor in the acquisition and transmission of human immunodeficiency virus (HIV) infection and has contributed to the spread of this disorder. Risk factors for genital herpes HSV-2 are strongly related to lifetime number of sexual partners, number of years of sexual activity, male homosexuality, black race, female gender and a history of previous sexually transmitted diseases (STD). Understanding the epidemiology of genital herpes is of great importance in limiting the spread of this STD. In this review, we summarise current knowledge related to the epidemiology of genital herpes.

Kinetics of Chlamydia trachomatis clearance in patients with azithromycin, as assessed by first void urine testing by PCR and transcription-mediated amplification

METHODS

Test-of-cure of 19 patients with Chlamydia trachomatis genital infection was assessed by daily collection of first void urine for 7 days just after treatment by azithromycin single-dose.

RESULTS

Detection by PCR and TMA of C. trachomatis showed a good correlation between both methods. The observation that post-therapy chlamydial nucleic acid detection is associated to bacterial clearance suggests that all the patients were cured.

Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women

OBJECTIVE

To investigate the impact of HIV infection on the prevalence, incidence and short-term prognosis of squamous intraepithelial lesions (SIL), in a prospective study with 1-year follow-up.

METHODS

Between 1993 and 1995, 271 HIV-positive and 171 HIV-negative women at high risk of HIV infection were recruited, 365 (82.6%) of whom completed the 1-year follow-up. The women underwent a Papanicolaou smear test at inclusion and at 6 and 12 months. Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR.

RESULTS

The SIL prevalence ranged from 7.5% for HIV-negative to 31.3% for HIV-positive women with CD4 cell counts < 500 x 10(6)/l (P < 0.001). Other factors associated independently and significantly with SIL prevalence were HPV-16, 18, 33 and related types, HPV-31, -35, -39 and related types, lifetime number of partners, younger age, past history of SIL and lack of past cervical screening. The SIL incidence ranged from 4.9% in HIV-negative women to 27% in HIV-positive women with CD4 cells < 500 x 10(6)/l (P < 0.001). Progression from low- to high-grade SIL during follow-up was detected in 38.1% of HIV-positive women with CD4 cells < or = 500 x 10(6)/l but in no HIV-negative nor HIV-positive women with CD4 cells > 500 x 10(6)/l. HPV-16, 18, 33 and related types were also associated with higher incidence of SIL and progression from low- to high-grade SIL.

CONCLUSION

HIV-induced immunodeficiency is associated with high prevalence, incidence and persistence/progression of SIL. A pejorative influence of HIV infection without marked immunodeficiency is less clear. HIV-positive women with SIL may thus benefit from early treatment when a useful immune response is still present.

[Sexually transmitted diseases and travel]

Travelers are highly exposed to acquiring sexually transmitted diseases especially since the most popular destinations are high risk areas. While this risk applies to all travelers, it is highest for the "sex" tourist who is typically a male with a mean age of 38 years. Awareness of risks is still incomplete, especially with regard to HIV. Several studies have shown that only 20% to 70% of travelers use condoms. This finding accounts for the high incidence of sexually transmitted diseases in returning travelers: 2% to 10%. The risk of HIV infection is particularly high for persons living abroad. Based on available data, we can define the typical profile of the high risk traveler who should be targeted for prevention. Prevention depends on providing adequate information before departure, especially concerning HIV infection. Use of a condom throughout sexual contact is a basic safety rule. However condom quality is poor in many developing countries. Returning travelers should seek medical advice if manifestations involving the anogenital regions should appear.

Genital herpes: epidemiology and pathophysiology. Update and new perspectives

Genital Herpes simplex virus (HSV) is a sexually transmitted disease (STD) which affects millions of people worldwide and is mainly due to HSV type 2. Seroprevalence rates as high as 60-90% have been reported in developing countries. In developed countries, 20% of the general population is HSV2 seropositive. Recent epidemiological surveys employing type-specific antibody assays show that the prevalence of HSV-2 infections is rising at an alarming rate. Also, the epidemiology is changing with an increasing incidence of first episodes caused by HSV-1. The natural history of HSV infection includes acute or subclinical first episode mucocutaneous infection, establishment of neuronal latency, and intermittent virus reactivation with or without associated symptoms. Although this sequence of events has been recognized for more than five decades, little is known about the exact mechanism of latency and reactivation. Almost all persons with HSV2 infection will have recurrences. Recent data show that many of these infections are subclinical: subclinical shedding can be documented in over 80% of HSV2 seropositive individuals who deny subclinical lesions. This suggests that patients shed virus and transmit it even in the absence of clinical signs and that genital herpes should be redefined as a chronic rather than an intermittent disease.

Evaluating the process of tailoring the global HIV/AIDS practice guidelines for use in developing countries

OBJECTIVE

To describe a systematic procedure for adapting, or 'tailoring' the World Health Organisation's 'global guidelines for the management of HIV/AIDS in adults and children' for use in two developing countries: Malawi and Barbados.

DESIGN

In order for these guidelines to achieve reproducibility, clinical flexibility, and clinical applicability, a systematic procedure is needed to tailor the guidelines to the local practice conditions of specific settings.

METHODS

A group of local experts in each country used a nominal group process to modify the global program on AIDS (GPA) guidelines for local use. Semantic analysis techniques, known as clinical algorithm nosology (CAN), were used to compare the two modified guidelines with the global ones to determine the extent and type of differences between sets of guidelines.

RESULTS

Standard, locally-tailored algorithm map guidelines (AMG) were developed within 4 months. CAN semantic analysis showed that guideline structure was maintained; 572/858 (66.6%) decision nodes were found to be the same in the GPA/Malawi, GPA/Barbados and Malawi/Barbados comparisons. However, different guideline versions managed patients quite differently, as evidenced by clinical algorithm patient abstraction (CAPA) scores of between 0 and 8.46 (0 = different; 8 = similar; 10 = identical). Analysis of the 197 specific differences found in these abstractions showed that 83% were in approaches to diagnosis and therapy, while the remaining 17% related to disease prevalence.

CONCLUSIONS

Standard techniques involving consensus used to develop clinical guidelines can also be employed to tailor these guidelines to local settings. Semantic analysis shows that the tailoring preserves structure but may involve significant modification to the processes of clinical care that could in turn affect care outcomes.

Tuberculosis and human immunodeficiency virus infection in west Burkina Faso: clinical presentation and clinical evolution

OBJECTIVE

To study the relationship between human immunodeficiency virus (HIV) infection and tuberculosis (TB) in a West African country.

DESIGN

A cohort study in TB patients at the TB centre of Bobo Dioulasso, Burkina Faso.

RESULTS

HIV seroprevalence rose from 12.5% in 1987 to 24.7% in 1990. Analysis of clinical findings showed that extra-pulmonary TB was not more frequent in HIV-positive patients (18.5%) than in HIV negative patients (17.3%). Four symptoms were independently associated with HIV infection: diarrhoea, lymphadenopathy, weight loss and oral candidiasis. At the end of six months of chemotherapy for TB (2SHRZ/4HR), the mortality rate among HIV-positive TB patients was 27%, versus 10% among HIV-negative TB patients (P < 0.001). There was no difference between treatment failure rates among HIV-positive patients (3.8%) and HIV-negative patients (3.9%). At the final evaluation, 18 months after the start of chemotherapy, the relapse rate was 8% in HIV-positive patients versus 5.6% in HIV-negative patients (NS). Global mortality rate during the whole study period was significantly higher in HIV-1 (40.3%) and HIV-1 + 2 (20%) patients than in HIV-2 (11.1%) and HIV-negative (12.9%) patients.

CONCLUSION

We conclude that, according to previous African studies, despite a higher mortality rate due generally to HIV disease itself, short-course chemotherapy of 6 months is as effective in HIV-positive patients as in HIV-negative patients, and must be continued.

Neisseria gonorrhoeae RNA/DNA hybridization and culture for screening of gonococcal infections in a low-prevalence population

Gonorrhea is still a major sexually transmitted disease (STD) worldwide. Its etiologic diagnosis is based on identification of the causative agent, Neisseria gonorrhoeae, by culture of genital secretions, which is often hampered by difficulties of sample collection and transport. Alternatively, nucleic acid hybridization techniques for routine diagnosis of N. gonorrhoeae appear to be useful by eliminating problems associated with bacterial viability, particularly for surveillance of low-prevalence populations. Our study among 1,508 outpatients undergoing routine examination for common STDs used RNA/DNA hybridization with a DNA probe specific for N. gonorrhoeae (Gen Probe Pace 2) and classical culture. Of the 1,750 specimens tested, 12 were positive by DNA probe and culture. In 8 cases, only DNA probe was positive while culture was negative. In 3 of these discrepant cases clinical and epidemiological data suggested true N. gonorrhoeae infection. Thus, DNA probe assay for N. gonorrhoeae may greatly improve screening of N. gonorrhoeae among low-prevalence populations. However, culture remains mandatory for testing antimicrobial resistance of these highly communicable infectious agents.

Trends in HIV infection among sexually transmitted disease patients in Paris

OBJECTIVE

To assess trends in HIV infection among sexually transmitted disease (STD) patients.

DESIGN

Repeated unlinked anonymous survey, 1991-1993.

SETTING

STD clinics in Paris, France.

SUBJECTS

Patients (n = 4354) with a new suspected STD.

METHODS

HIV antibody testing, using blood from syphilis samples.

RESULTS

HIV prevalences were stable over time in all transmission groups. One-third of homo-/bisexual men were HIV-positive. Prevalence was 2.5 times higher among heterosexual patients from Africa or the Caribbean than among those from other countries. Among patients under 25 years of age prevalence significantly decreased from 4.3% in 1991 to 0.8% in 1993 (P = 0.01). Among homo-/bisexual men, despite a 50% reduction in the incidence of STD, the absolute number of those newly HIV-infected remained stable; median age increased from 28 years in 1991 to 32 years in 1993 (P = 0.02). Among heterosexuals, trends in HIV incidence were difficult to assess: recently infected patients were more likely to be identified in 1993 than in 1991, since the proportion of patients who reported a recent HIV-negative test increased over time.

CONCLUSION

Prevalence studies contribute to define specific subgroups which should be targeted for prevention (HIV-positive or older homosexuals, heterosexuals from Africa and the Caribbean). Despite a decrease in both overall STD incidence and HIV prevalence among patients aged under 25 years, overall HIV incidence has not decreased, at least among homo-/bisexual men in whom recent HIV infections occurred at a high rate overall, and increased in those aged 35 years or more. Sentinel site-based HIV seroprevalence studies are best interpreted in the light of results obtained from different populations and through routine surveillance of STD.

Cervicovaginal anti-HIV antibodies in index women from HIV-discordant, exclusively heterosexual, couples

Cervicovaginal IgA and IgG anti-gp160 antibodies were evaluated in cervicovaginal secretions from twelve HIV-discordant heterosexual couples, matched with twelve HIV-concordant heterosexual couples, at similar stage of HIV disease. The mean reciprocal end-point titers of cervicovaginal IgA or IgG to gp160 were similar in cases and in controls. These observations suggest that cervicovaginal antibodies to HIV do not appear as biological indicators sufficiently relevant to explain a possible reduced infectivity of the female index case in HIV-discordant couples, by comparison with HIV-concordant couples.

Mother-to-child transmission of human immunodeficiency virus type 1 and type 2 and dual infection: a cohort study in Banfora, Burkina Faso

A prospective cohort study on the mother-to-child transmission of human immunodeficiency virus type 1 (HIV1), type 2 (HIV2) and dual positivity (HIV1 + HIV2) was carried out in Banfora, West Burkina Faso. The study samples consist of 117 newborns of HIV-seropositive women matched to 234 newborns of HIV-seronegative women. Among cases, 91 were born of HIV1-seropositive mothers, 15 were born of HIV2-seropositive mothers and 11 were born of HIV1 and HIV2 dual-seropositive mothers and were included in an 18-month follow-up. Calculation of the mother-to-child transmission rate was according to the recommendations of the European Economic Community working group. The HIV1 mother-to-child transmission rate was estimated to be 27.8% (95% confidence interval (CI) 24.5 to 32.4) with one method and 25.5% (95% CI 13.5 to 37.5) with a second method. For HIV2, this rate was estimated to be 29.5% (95% CI 26.0 to 39.8) and was not statistically different from the HIV1 mother-to-child transmission rate. No case of transmission was observed in children born of dual seropositive mothers. Survival rate at month 18 was significantly lower for children born of HIV1 mothers: 83.7% (95% CI 78.2 to 92.2). Survival rates were similar between children born of HIV2-seropositive (86.7), dual HIV1 + 2-positive (100) and seronegative mothers (92.0%). Findings suggest a higher mother-to-child transmission rate of HIV2 in children born in Burkina Faso than in Europe and a low clinical expression of HIV2 in children.

Proinflammatory cytokine expression in cervicovaginal secretions of normal and HIV-infected women

Proinflammatory cytokines may stimulate replication and spread of HIV. To evaluate to what extent the female genital tract represents a source of these cytokines, we determined TNF-alpha, IL-1 beta and IL-6 concentrations in paired serum and cervicovaginal washings from 45 HIV-negative and 50 HIV-positive women, and then we looked for the relevant mRNAs in cervicovaginal secretions by RT-PCR. Cytokines were detected by ELISA in cervicovaginal fluid from most healthy women. Cervicovaginal washing levels of TNF-alpha were increased above the control value +2 SD in 11/50 HIV-positive women, those of IL-1 beta in 13/50, and those of IL-6 in 14/50. The prevalences of TNF-alpha, IL-1 beta and IL-6 increase and their levels in cervicovaginal washings were significantly higher in the 20 patients at stage IV than in the 30 patients at earlier stages of the disease. In HIV-infected patients, serum and cervicovaginal washing levels correlated positively for TNF-alpha and IL-6, but not for IL-1 beta. Nine of 15 cytokine mRNAs determinations were positive in HIV-infected women versus 1 of 15 in controls (P < 0.01). These findings could be relevant to bidirectional heterosexual transmission of HIV.

HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso

OBJECTIVE

To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso.

RESULTS

Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001).

CONCLUSIONS

Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.

Geographical and ethnical distribution of HBs antigen subtypes in Mauritania

A survey conducted in sera from 515 black and 499 white individuals living in 8 villages of Mauritania showed an HBs Ag prevalence of 15.7%. Two main subtypes, ayw2 (34.7%) and ayw4 (63%), were found in this country which is a junction area between North and West Africa and where 2 ethnic groups are living close one to the other but with very rare cross-breeding. ayw2 was more prevalent in the driest part of the country (North) and ayw4 in the South. Analysis of the subtype distribution in each village indicates that there is no relationship between HBs Ag subtype and ethnic groups, but there is a correlation between HBs Ag subtype and the geographical location of the villages.