摘要:

Objectives:To investigate (1) the frequency of clinical resistance to oral polyenes or azole treatment for oral candidiasis, (2) the frequency of resistantin vitro Candidastrains, (3) the relationship between the susceptibilities ofin vitro Candidaspecies andin vivostatus in HIV patients.Design:Prospective cross-sectional study.Setting:Tertiary care clinic at Bocage Hospital, Dijon, France.Patients:HIV-infected patients with and without oral candidiasis.Interventions:Clinical examination, oral swab for mycologic investigations.Main outcome measures:Clinical diagnosis of oral candidiasis, identification of the antifungal treatment given within the previous month, identification ofCandidaspecies, antimycogramm and determination of the minimal inhibitory concentration (MIC) for fluconazole, and measurement of T-helper cell count.Results:Within a 2-month period, 154 HIV-infected patients were studied: 46 heterosexuals, 51 intravenous drug users (IVDU), 52 homosexuals and five blood transfusion recipients. The percentages of patients with oral candidiasis were: 41, 80, 44 and 20%, respectively (P<0.05); the mean T-helper cell counts were 200, 135, 210 and 238×106/l cells, respectively (P<0.05). Twenty-two patients (14.3%) had received recent azole treatment and 29 (18.8%) recent oral polyene treatment. Among the 84 patients with and the 70 patients without oral candidiasis, 78 and 28Candidastrains were isolated, respectively. AlthoughCandida albicansrepresented the majority ofCandidaspecies (88 strains, 83%), the non-albicansstrains were isolated more frequently in patients who had received recent antifungal treatment. No strains were resistant to ketoconazole, miconazole or econazole; however, six (5.6%), 16 (15%) and 10 (9.5%) were intermediately susceptible to the three drugs, respectively. Twelve (1 3.6%) of the 88C. albicans, five of the sixC. (Torulopsis) glabrata, one of the fiveC. tropicalisand all threeC. kruseistrains were resistant to fluconazole. These resistant strains were separated as follows: 41.1% ofC. albicansstrains resistant to fluconazole were isolated from patients who had received recent azole therapy, 1 7.6% from patients who received recent oral polyene, and 3.7% from patients who had not received any recent antifungal treatment (P= 0.004). The mean MIC of these three categories of isolates were 3.6, 1.6 and 0.6mg/l, respectively (P=0.06).Conclusions:Oral candidiasis and fluconazole-resistantCandidaisolates are more frequently found in IVDU. Treatments using azoles select non-albicansstrains and are associated with decreased susceptibilities ofC. albicansstrains to fluconazole in particular. These findings show that prolonged azole treatment in severely immunocompromised patients should be avoided.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objectives:To determine the age- and sex-specific prevalence of HIV-1 infection in a general ambulatory population in northern Thailand in 1990 and 1992, and the incidence of HIV-1 infections between 1990 and 1992.Design:Health fairs were held in five villages in Chiang Mai province in northern Thailand between December 1989 and January 1990 and again in January 1992. Participation of all village residents was encouraged. Villagers were offered testing for serological markers of hepatitis B virus (HBV) infection and free HBV vaccine was made available to susceptible individuals.Methods:Sera from the two surveys were linked and coded by demographic characteristics (age group and sex). Individual identifiers were removed and the sera tested for HIV-1 antibodies by enzyme-linked immunosorbent assay with Western blot confirmation.Results:In 1990, 21 out of 1161 (1.8%) individuals were HIV-1-seropositive; the infection rates were 3.3% in men and 0.5% in women. In 1992, 44 out of 956 (4.6%) individuals were HIV-1-seropositive. Among people included in both surveys the 2-year incidence was 2.0% in women and 4.1% in men (annual incidence, 1.0 and 2.05%, respectively); however, among men over the age of 14 years the 2-year incidence was 6.3%, whereas among women of this age the 2-year incidence was 1.8% (annual incidence, 3.15 and 0.9%, respectively). Among men, incident HIV-1 infections were common, even among those aged 50 years or more.Conclusions:Infections with HIV-1 are disturbingly frequent and increasing among adult populations in semi-rural areas of northern Thailand. In order to contain further spread of the epidemic public-health strategies targeted to the general public, including those in rural areas, will be needed.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To describe more fully HIV-1 and tuberculosis (TB) coinfection in TB patients attending New York City Department of Health chest clinics (1989–1991) and one inner-city hospital (1990–1991).Design:An unlinked serosurvey using HIV-1-antibody testing of remnant blood specimens collected for routine medical purposes.Subjects:A total of 1414 clinic and 856 hospital patients.Outcome measures:HIV seropositivity and TB infection/disease.Results:A total of 327 (23%) of the clinic patients were HIV-1-positive, with a significantly higher seroprevalence in men (29 versus 15%,P< 0.001) and in young and middle-aged adults aged 30–50 years (PConclusions:There is considerable overlap between the TB and HIV epidemics in New York City; a part of the increasing TB incidence may be independent of HIV coinfection. The control of TB will necessitate prompt diagnosis of TB and HIV-1, appropriate TB treatment and/or chemoprophylaxis, and a greater commitment to tackle the social conditions associated with the spread of the disease.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine if β2-microglobulin (β2M) predicts death among HIV-infected African women.Design:Nested case-control study.Setting:Kigali, Rwanda.Participants:Two hundred and five seroprevalent women known to be HIV-infected since 1986–1987; 67 of whom died of HIV disease (cases) and 138 were alive (controls) as of November 1991. In addition, 128 women who seroconverted between 1986 and 1991.Main outcome measures:HIV serology, clinical signs and symptoms of HIV disease, hematology variables, and β2M concentration.Results:β2M concentration increased over time (P< 0.001) in the seroprevalent women and seroconvertors. The average rate of β2M increase in women who died was 0.5 compared with 0.3 mg/l/year in the vital, seroprevalent women (P=0.07). The strongest independent predictors of death were the rate of change of β2M (mg/l/year) [odds ratio (OR), 3.4; 95% confidence interval (Cl), 1.7–6.8] and baseline β2M concentration (mg/l) [OR, 1.6; 95% Cl, 1.2–2.1]. The rate of death for women with β2M concentration ≥ 7.0 mg/l and a rate of change of β2M ≥0.4 mg/l/year was 7.3 times higher than for women with β2M concentration < 7.0 mg/l and a rate of change of β2M of < 0.4 mg/l/year (95% Cl, 3.1–1 7.2). The estimated median time from seroconversion to death assuming a constant rate of change of β2M was 10.6 years (95% Cl, 9.9–11.2) for this cohort of HIV-infected women.Conclusions:Elevated β2M and a high rate of β2M increase were strongly associated with mortality among HIV-infected African women. Based on survival estimates using the rate of change of β2M, HIV-infected African women have similar survival compared with HIV-infected adults in the United States.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objectives:To measure the prevalence of HIV-1 infection in different subgroups of blood donors and to identify groups at high risk of acquiring HIV-1.Methods:Between March 1988 and April 1991 all blood donors at llembula Lutheran Hospital, Tanzania were asked about their age, marital status, home village and occupation, and tested for the presence of HIV antibodies using a first generation, whole virus lysate enzyme-linked immunosorbent assay (ELISA). Some negative (n = 265) and nearly all positive samples (439 out of 485) were subjected to confirmatory testing including recombinant and peptide-based ELISA and Western blot assays.Results:A total of 3474 male and 1287 female blood donors were studied. The overall HIV-1 prevalences for men and women were 6.6 and 7.0%, respectively, with a higher prevalence in urban villages (13.6 and 15.0%, respectively), an intermediate prevalence in semi-urban villages (7.2 and 7.9%, respectively), and a lower prevalence in rural villages (3.7 and 3.0%, respectively). HIV-1 infection occurred mostly in men aged 20–44 and women aged 15–34 years. Urban donors, but not semi-urban and rural donors from the highlands, had a higher HIV-1 prevalence (21.4%) than the corresponding group from the lowlands (10.2%). Apart from area of residence, HIV-1 infection was found to be associated with occupation and marital status. There was an increase in HIV-1 prevalence, although not statistically significant, during the period studied. None of the blood donors were positive for HIV-2.Conclusions:Male and female donors from urban and semi-urban villages, non-farmers from urban villages, and unmarried donors were identified as high-risk groups, which is consistent with more extensive risk behaviour in urban communities. In addition to using an HIV test with high sensitivity, the importance of pre-donation selection of blood donors is stressed.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To investigate the clinical and immunologic effects, and pattern of mortality associated with HIV-2 infection.Setting:A rural community in Guinea-Bissau.Methods:Serologic screening of 2774 subjects aged>14 years followed by studies of the prevalence of clinical and immunologic abnormalities among 133 subjects with HIV-2 infection and 160 seronegative controls, and surveillance of mortality among all subjects who were screened during a mean of 2 years of follow-up.Results:Generalized lymphadenopathy was the only clinical abnormality significantly associated with HIV-2 infection. Infection was associated with lower CD4 counts and higher β2-microglobulin and neopterin levels. During follow-up, 5.5% of infected subjects died compared with 1.8% of the seronegatives (rate ratio adjusted for age and sex, 3.5; 95% confidence interval ((Cl), 1.8–6.7). Proportional hazard regression analysis showed that the rate ratio varied with age (P= 0.003) and there was some evidence that the excess of mortality in infected subjects was, in absolute terms, least in the oldest subjects (trend test;P=0.08).Conclusions:The findings support previous suggestions that HIV-2 is less pathogenic than HIV-1; the data also suggest that mortality associated with infection may be lower in older subjects.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To estimate the seroincidence of HIV-1 infection among women of reproductive age in Kigali, Rwanda.Design:Fixed prospective cohort followed for 36 months between November 1988 and June 1992, as part of an ongoing study of mother-to-child transmission of HIV-1.Setting:Centre Hospitalier, Kigali, Rwanda.Subjects:A total of 216 HIV-seronegative women were enrolled at delivery between November 1988 and June 1989.Methods:A blood sample was obtained at delivery to test for HIV antibodies (by enzyme-linked immunosorbent assay and Western blot). Serum was tested every 3 months during follow-up. Incidence density rates of HIV seroconversion were estimated.Results:The follow-up rate after 3 years was 89%, assessed by the maximum person-years method. The seroincidence density rate was 3.5 per 100 women-years (95% confidence interval, 1.9–5.0). It decreased linearly from 7.6 during the first 6-months postpartum to 2.5 per 100 women-years during the last 6 months of the third year of follow-up. Maternal age did not affect HIV incidence rates. We examined the role of the cohort, counselling, and the first 6-month postpartum effects on this estimate.Conclusion:This fixed cohort provided an overall estimation of the HIV infection incidence rate and its dynamics. These figures could be used for programming future HIV preventive vaccine efficacy trials in Rwanda.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:Little is known about variations in patterns of sexual behaviour in different countries, cultures, and subpopulations that determine the spread of HIV-1. Quantitative studies are required to improve understanding.Methods:To assess reported patterns of sexual behaviour, we administered a standardized questionnaire to 416 men and 498 women aged 15–49 years from a rural population in northwest Tanzania.Results:Reported levels of sexual activity were highest in men and among younger age groups. The number of sexual partners and number of sex acts per unit of time were strongly correlated: men reported 10 times as many lifetime partners than women. Frequency of sexual partner exchange plateaued earlier in women (by age 25 years) than in men (by age 35 years). For the great majority, age of first intercourse was 1 5 years or younger; older subjects were older at first intercourse and had fewer lifetime partners than younger subjects.Conclusions:This age-related pattern suggests that more recent birth cohorts have behaviour patterns that increase the risk of sexually transmitted infectious agents such as HIV. Preventive education programmes should be targeted at young adults, who adopt higher risk profiles of frequent partner exchange linked with first intercourse at an early age.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To estimate the effects of the HIV-1 epidemic on mortality in children under 5 years of age in urban and rural populations in eastern and central, and southern Africa.Method:A lifetable method that allows for the effects of competing causes (i.e., mortality due to HIV and other causes) was used to estimate mortality. Our calculations used published and unpublished data on HIV-1 infection in African adults and children (incidence and prevalence, vertical transmissions, transmission by blood transfusion and natural history), and typical baseline fertility and child mortality data. The results were applied to model rural and urban populations to explore the effects of parameters such as mortality in HIV-1-infected children, fertility in infected mothers and overall population growth.Results:We estimate that child mortality will rise substantially because of the prevalence of HIV-1 in urban areas. There will be little difference in the absolute levels of increase in mortality between areas in eastern and central, and southern Africa with similar levels of HIV infection; however, in relative terms the effect will be more noticeable in southern Africa because of the lower baseline mortality. Towns with severe epidemics (30% adult seroprevalence) might experience a rise in child mortality of one-third in eastern and central Africa and three-quarters in southern Africa. This will cancel or reverse existing advantages in urban over rural levels of child mortality and this effect will be more pronounced in southern Africa. The exact impact of HIV-1 will vary according to mortality among HIV-1-infected children and to fertility among infected women. However, changes in age structure and population growth have relatively little impact on mortality.Conclusions:There are likely to be substantial increases in child mortality in sub-Saharan Africa as a result of HIV-1 infection. The main determinant of childhood infection is the scale of the epidemic among adults. Increases in mortality will depend on local adult seroprevalence but are hard to predict precisely because of possible variation in death rates among HIV-1-infected children. In rural areas with low seroprevalence other diseases will remain the main cause of mortality. However, in urban areas families and health services will have to face considerably increased demands from ill and dying children.

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0269-9370    

出版商:OVID    

年代:1994

数据来源: OVID