99 results on '"University of Natal"'
Search Results
2. Acceptance and disclosure of HIV status through an integrated community/home-based care program in South Africa.
- Author
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Ncama BP
- Subjects
- Adaptation, Psychological, Adult, Confidentiality, Continuity of Patient Care organization & administration, Cross-Sectional Studies, Developing Countries, Female, Focus Groups, HIV Infections diagnosis, HIV Infections therapy, Humans, Male, Middle Aged, Models, Organizational, Nursing Evaluation Research, Nursing Methodology Research, Outcome Assessment, Health Care, Patient Acceptance of Health Care statistics & numerical data, Program Evaluation, Stereotyping, Surveys and Questionnaires, Community Health Services organization & administration, HIV Infections psychology, Home Care Services organization & administration, Patient Acceptance of Health Care psychology, Truth Disclosure
- Abstract
Aim: To report the outcome of a comparative study among people living with HIV/AIDS (PLWHAs) served by an integrated community/home-based care (ICHC) programme and those who are not in any home-based care programme in terms of acceptance and disclosure of the HIV status., Background: One of the major challenges in HIV/AIDS care in developing countries is acceptance and disclosure of a positive HIV status by PLWHAs. Denial and non-disclosure of HIV status hinders prevention efforts as well as access to treatment, care and support for PLWHAs., Methods: Quantitative data were collected in 2004 from a group of PLWHAs served by the ICHC programme and a group that was not receiving any community/home-based care. Data were compared between the two groups in terms of acceptance and disclosure of HIV status., Findings: The ICHC was effective in improving acceptance and disclosure of the HIV-positive status by PLWHAs in the programme. PLWHAs in the ICHC programme did not find disclosure of their status difficult, and had disclosed their positive HIV status to more people than those who are not in any programme. PLWHAs in the ICHC programme not only disclosed their positive HIV status within their family network and households, but also disclosed to the community in general, sports group, religious groups and other social networks., Conclusions: Community/home-based care programmes can serve as catalysts for acceptance and disclosure of a positive HIV status by PLWHAs. more...
- Published
- 2007
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3. Challenges in the provision of ICU services to HIV infected children in resource poor settings: a South African case study.
- Author
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Jeena PM, McNally LM, Stobie M, Coovadia HM, Adhikari MA, and Petros AJ
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- Child, Child, Preschool, Costs and Cost Analysis, Drug Costs, HIV Infections economics, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric economics, Intensive Care Units, Pediatric supply & distribution, Pneumocystis, Pneumonia, Pneumocystis economics, Pneumonia, Pneumocystis therapy, South Africa, Developing Countries, Ethics, Clinical, HIV Infections therapy, Intensive Care Units, Pediatric ethics, Patient Selection ethics
- Abstract
The HIV/AIDS epidemic has placed increasing demands on limited paediatric intensive care services in developing countries. The decision to admit HIV infected children with Pneumocystis carinii pneumonia (PCP) into the paediatric intensive care unit (PICU) has to be made on the best available evidence of outcome and the ethical principles guiding appropriate use of scarce resources. The difficulty in confirming the diagnosis of HIV infection and PCP in infancy, issues around HIV counselling, and the variance in the outcome of HIV infected children with PCP admitted to the PICU in African studies compound this process. Pragmatic decision making will require evaluation of at least three ethical questions: are there clinical and moral reasons for admitting HIV positive children with PCP to the PICU, should more resources be committed to caring for HIV children who require the PICU, and how can we morally choose candidates for the PICU? Those working in the PICU in HIV endemic regions need to make difficult personal decisions on effective triage of admissions of HIV infected children with PCP based on individual case presentation, availability of resources, and applicable ethical principles. more...
- Published
- 2005
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4. Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence.
- Author
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Sturm PD, Moodley P, Khan N, Ebrahim S, Govender K, Connolly C, and Sturm AW
- Subjects
- Animals, Chlamydia trachomatis isolation & purification, HIV Infections complications, Herpesvirus 2, Human isolation & purification, Humans, Male, Mycoplasma genitalium isolation & purification, Neisseria gonorrhoeae isolation & purification, Prevalence, Sexually Transmitted Diseases etiology, Trichomonas vaginalis isolation & purification, Ureaplasma urealyticum isolation & purification, HIV Infections epidemiology, HIV-1, Urethritis epidemiology, Urethritis etiology
- Abstract
The aetiology of urethritis, the significance of potential pathogens and the relation of urethritis to HIV infection were determined in 335 men (cases) with and 100 men (controls) without urethral symptoms. Urethral swab specimens were tested for different organisms by PCR or by culture for Neisseria gonorrhoeae. The prevalence of N. gonorrhoeae and Chlamydia trachomatis was 52 and 16%, respectively. The potential pathogens: Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis and herpes simplex virus (HSV), were present in 5, 36, 6 and 6% of the cases respectively. M. genitalium was the only potential pathogen associated with microscopic urethritis. After excluding gonococcal infections, U. urealyticum was more frequent in symptomatic patients, while the prevalence of T. vaginalis was similar among cases and controls. These results strongly suggest an a etiological role for M. genitalium in male urethritis, a possible role for U. urealyticum, but not for T. vaginalis. The control group, with 97% genital ulcer disease patients, was not suitable for the investigation of the role of HSV. The sero-prevalence of HIV was 45%. Current infections were not associated with HIV. However, a history of previous urethral discharge was associated with HIV in a multivariate analysis and supported the hypothesis that non-ulcerative sexually transmitted diseases facilitate HIV transmission. more...
- Published
- 2004
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5. Lymphocyte changes in pregnancy: a comparison of the human immunodeficiency virus infected and non-infected women.
- Author
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Ibrahim T, Moodley J, and Doorasamy T
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- Adult, CD4-Positive T-Lymphocytes, CD8-Positive T-Lymphocytes, Cross-Sectional Studies, Female, Flow Cytometry, Humans, Lymphocyte Count, Postpartum Period immunology, Pregnancy Trimesters immunology, HIV Infections immunology, Pregnancy immunology, Pregnancy Complications, Infectious immunology
- Abstract
The aim of this study was to assess cellular immunological changes in HIV infected and non-infected normal pregnancies. This was a cross-sectional study of women in the three trimesters of pregnancy and the postpartum period. All participants were asymptomatic. This study showed that absolute numbers of CD4 counts in the HIV infected group were significantly lower than that in the non-infected group, for all periods of gestation studied. The CD8 counts were found to increase postdelivery and may have clinical significance in relation to mother to child transmission. This needs further study with a larger sample size and a longitudinal design method of study. more...
- Published
- 2004
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6. The knowledge and attitudes of traditional birth attendants towards HIV/AIDS and their beliefs related to perinatal care: a study conducted in KwaZulu Natal.
- Author
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Mchunu GG and Bhengu BR
- Subjects
- Adult, Aged, Community Health Centers organization & administration, Female, Focus Groups, HIV Infections transmission, Humans, Infection Control methods, Maternal-Child Nursing education, Maternal-Child Nursing methods, Middle Aged, Nursing Methodology Research, Pregnancy, Primary Health Care organization & administration, Referral and Consultation organization & administration, Risk Factors, Rural Health Services organization & administration, South Africa, Surveys and Questionnaires, Attitude of Health Personnel, HIV Infections prevention & control, Health Knowledge, Attitudes, Practice, Midwifery education, Midwifery methods, Perinatal Care methods, Pregnancy Complications, Infectious prevention & control
- Abstract
Traditional birth attendants (TBAs) are still mainly being utilized in the rural areas even in the presence of the formal health care facilities. Studies reveal that the utilization of TBAs is beneficial in some other contexts with some support and supervision from the western health sector. In order to develop further training for TBAs the researchers deemed it necessary to assess their knowledge, attitudes and beliefs related to HIV/AIDS, prenatal care, delivery and postnatal care. This was a survey of an identified group of TBAs who had already received some training and were currently practicing in the catchment areas. Five Primary health care (PHC) clinics from Abaqulusi sub-district in Zululand Health District, Kwa-Zulu Natal Province, were selected as sites for the focus groups. A total of 57 TBAs participated in focus groups and completed a questionnaire. The HIV/AIDS knowledge questionnaire consisted of 16 questions about transmission, symptoms, course of the disease and its risk factors. An assessment tool was used to assess attitudes, beliefs and practice in relation to pregnancy, delivery and postnatal care. The results of this study demonstrated that the TBAs have a good knowledge of what they are doing. more...
- Published
- 2004
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7. Perinatal tuberculosis and HIV-1: considerations for resource-limited settings.
- Author
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Pillay T, Khan M, Moodley J, Adhikari M, and Coovadia H
- Subjects
- Africa, Southern, Anti-Retroviral Agents adverse effects, Anti-Retroviral Agents therapeutic use, Antitubercular Agents adverse effects, Antitubercular Agents therapeutic use, Female, HIV Infections drug therapy, HIV Infections mortality, Humans, Infant Mortality, Infant, Newborn, Maternal Mortality, Perinatal Care, Pregnancy, Pregnancy Outcome, Risk Factors, Tuberculosis drug therapy, Tuberculosis mortality, Viral Load, HIV Infections transmission, HIV-1, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious mortality, Tuberculosis transmission
- Abstract
Tuberculosis is the commonest HIV-1-related disease and the most frequent cause of mortality in young women in endemic regions. Tuberculosis and HIV-1 are independent risk factors for maternal mortality and adverse perinatal outcomes, and in combination have a greater impact on these parameters than their individual effects. In referral health centres in southern Africa around one-sixth of all maternal deaths are due to tuberculosis/HIV-1 coinfection. One-third (37%) of HIV-1-infected mothers with tuberculosis are severely immunocompromised, with CD4 counts of fewer than 200 cells/microL compared with 14-19% in mothers recruited into major mother-to-child intervention trials in Europe. Babies born to mothers with tuberculosis/HIV-1 also have higher rates of prematurity, low birthweight, and intrauterine growth restriction. Transmission rates of HIV-1 from mother to infant are around 25-45% in resource-limited settings, while that for mother-to-child-transmission of tuberculosis is 15% within 3 weeks of birth. We highlight this emergent problem, and discuss the dilemmas associated with diagnosis and management of pregnant HIV-1-infected mothers with tuberculosis, and their newborn babies. more...
- Published
- 2004
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8. GB virus type C coinfection in HIV-infected African mothers and their infants, KwaZulu Natal, South Africa.
- Author
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Sathar MA, York DF, Gouws E, Coutsoudis A, and Coovadia HM
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- Cohort Studies, Female, Flaviviridae Infections complications, Flaviviridae Infections epidemiology, Flaviviridae Infections immunology, GB virus C genetics, HIV Infections complications, HIV Infections epidemiology, HIV Infections immunology, HIV Infections virology, Humans, Infant, Mothers, Pregnancy, RNA, Viral analysis, South Africa epidemiology, Flaviviridae Infections pathology, GB virus C isolation & purification, HIV Infections pathology
- Abstract
GB virus type C (GBV-C) infection was studied in a convenience sample of 75 antiretroviral (ART)-naive African mothers with human immunodeficiency virus infection and their infants. GBV-C RNA was extracted from serum and amplified by reverse-transcriptase polymerase chain reaction. Twenty-seven (36%) of these 75 HIV-infected women tested positive for GBV-C RNA. To study transmission dynamics, we chose a random subsample of 20 of these women and their infants. In this cohort, there was evidence of postnatal transmission of GBV-C; however, it was not possible to demonstrate evidence of in utero or intrapartum transmission. In this pilot observational study, transmission of HIV from mother-to-infant occurs independently of the GBV-C infection status of the mother. The immunological indices measured tend to suggest an association with protection and or delayed progression of HIV disease in GBV-C-infected mothers. more...
- Published
- 2004
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9. Gestational trophoblastic syndrome and human immunodeficiency virus (HIV) infection: a retrospective analysis.
- Author
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Moodley M and Moodley J
- Subjects
- Adolescent, Adult, Choriocarcinoma pathology, Female, Gestational Trophoblastic Disease pathology, Humans, Middle Aged, Retrospective Studies, Risk Factors, Survival Analysis, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Choriocarcinoma drug therapy, Gestational Trophoblastic Disease drug therapy, HIV Infections complications
- Abstract
The appropriate management of gynecological malignancies in association with human immunodeficiency virus (HIV) infection is not established. To date the reported literature on the subject consists mainly of case reports. Due to the increasing prevalence of HIV infection, especially in sub-Saharan countries, the chances of finding both conditions in the same patient has produced management and ethical dilemmas. This retrospective study describes the management of 12 HIV-infected patients and compares their outcome with 29 non HIV-infected patients. The mean age of the non HIV-infected patients was 30 years (range 16-56 years), while the mean age of the HIV-infected patients was 32 years (range 20-47 years). In terms of risk factors, there were 72% of non HIV-infected women in the high-risk category compared to 50% of HIV-infected women (P = 0.468). All patients who received treatment had CD4 counts greater than 200 cells/microl. Two HIV-infected women who did not receive any form of chemotherapy due to low CD4 counts (41 cells/microl and 84 cells/microl) demised of their disease. The majority of women (86% non HIV-infected & 90% HIV-infected) received lfewer than 10 cycles of chemotherapy to attain cure. Most side effects were minor. None of the HIV-infected patients who received chemotherapy demised of their disease. In total, irrespective of risk category, there were 38 patients (93%) who were cured of their disease by chemotherapy including 10 HIV-positive patients. All patients were alive and free of disease at their last follow-up visit. Although the numbers are small, it is proposed that HIV-infected patients with choriocarcinoma and a reasonable degree of CD4 counts (>200cells/microl) should receive standard therapy. more...
- Published
- 2003
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10. Cardiac involvement in HIV-infected people living in Africa: a review.
- Author
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Magula NP and Mayosi BM
- Subjects
- Africa, Echocardiography, Heart Diseases diagnostic imaging, Humans, HIV Infections complications, Heart Diseases etiology
- Abstract
The primary objective of this study was to review and summarise the literature on the spectrum and management of cardiac disease in HIV-infected people living in Africa. We searched MEDLINE (January 1980 to February 2003), reference lists of papers, and reviews on the subject, and contacted experts working in the field for information on relevant references. The review was limited to papers that were published in peer-reviewed journals and indexed on MEDLINE. Seventeen of the 21 studies identified met the inclusion criteria for analysis. The studies confirmed that cardiac abnormalities are more common in HIV-infected people, compare to normal controls, and that about half of hospitalized patients and a significant proportion of patients followed up over several years develop cardiac abnormalities. The commonest HIV-related cardiac abnormalities were cardiomyopathy and pericardial disease. Tuberculosis was the major cause of large pericardial effusion in Africa. Myocarditis was the commonest pathological abnormality in HIV-associated cardiomyopathy, and non-viral opportunistic infections such as toxoplasmosis and cryptococcosis may account for up to 50% of cases of HIV-associated cardiomyopathy in Africa. Echocardiography is indicated in HIV-positive patients with cardiac symptoms or signs. If cardiomyopathy or pericardial disease is identified, further investigation must be considered to exclude potentially treatable opportunistic infections. Further research in large numbers of patients is needed to determine the value of endomyocardial biopsy in the management of patients with HIV-associated cardiomyopathy, and to establish the place of adjuvant steroids in the treatment of HIV-associated tuberculous pericarditis. more...
- Published
- 2003
11. Identification of women at high STD risk among STD clinic attendees: implications for STD programmes.
- Author
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Moodley P, Sturm PD, Connolly C, and Sturm AW
- Subjects
- Adolescent, Adult, Aged, Child, Female, Genital Diseases, Female epidemiology, Genital Diseases, Male epidemiology, HIV Infections epidemiology, HIV Infections transmission, Humans, Male, Middle Aged, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases transmission, South Africa epidemiology, Ambulatory Care Facilities, HIV Infections prevention & control, Sexually Transmitted Diseases prevention & control, Women's Health
- Abstract
We showed an association between current infection with a recognized sexually transmitted infection (STI) pathogen and HIV infection in women but not in men with non-ulcerative genital disease. While the accuracy of recognition of male urethritis and genital ulcer syndromes is high, this is significantly less for non-ulcerative STIs in women. The symptoms associated with the latter have a broad differential diagnosis including conditions of a non-STI nature. Local sexually transmitted disease (STD) clinic attendees often comprise patients with and without STIs. We hypothesized that this may be responsible for the association of current STI pathogens and HIV in women. To identify a group of women that would be representative of a true STD clinic population we looked at those with a past history of treated genital ulcers. When we analysed in this subset the association of current STI pathogen and HIV infection, a pattern emerged that was comparable with that in men. more...
- Published
- 2003
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12. Morbidity in children born to women infected with human immunodeficiency virus in South Africa: does mode of feeding matter?
- Author
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Coutsoudis A, Pillay K, Spooner E, Coovadia HM, Pembrey L, and Newell ML
- Subjects
- Adult, Child Development, Humans, Incidence, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Morbidity, South Africa epidemiology, Time Factors, Breast Feeding, HIV Infections epidemiology, HIV Infections transmission
- Abstract
Aim: To examine infant morbidity risks associated with refraining from breastfeeding where it is used in an attempt to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV)., Methods: The population consisted of infants born to HIV-infected women in South Africa who were participating in a vitamin A intervention trial to prevent MTCT of HIV. Women chose to breastfeed or formula feed their infants according to UNAIDS guidelines. Actual feeding practices and morbidity were recorded at clinic follow-up visits at I wk, 6 wk, 3 mo and every 3 mo thereafter until 15 mo of age or cessation of breastfeeding. The infant's HIV status was assessed according to a predetermined algorithm., Results: HIV-infected infants who were never breastfed had a poorer outcome than those who were breastfed; 9 (60%) of those who were never breastfed had 3 or more morbidity episodes compared with 15 (32%) of breastfed children [odds ratio (OR) 4.05, 95% confidence interval (95% CI) 0.91-20.63, p = 0.05]. During the first 2 mo of life, never-breastfed infants (regardless of HIV status) were nearly twice as likely to have had an illness episode than breastfed infants (OR 1.91, 95% CI 1. 17-3.13, p = 0.006)., Conclusion: The significant extra morbidity experienced in the first few months by all never-breastfed infants and at all times by HIV-infected infants who are not breastfed needs to be considered in all decisions by mothers, health workers and policy makers so as not to offset any gains achieved by decreasing HIV transmission through avoiding breastfeeding. more...
- Published
- 2003
13. Aspects of the care of people with HIV/AIDS in South Africa.
- Author
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Uys LR
- Subjects
- Adolescent, Adult, Attitude of Health Personnel, Attitude to Health, Child, Child, Preschool, Female, HIV Infections mortality, Humans, Infant, Infant, Newborn, Male, Middle Aged, Models, Nursing, Nursing Evaluation Research, Nursing Methodology Research, Qualitative Research, South Africa epidemiology, Surveys and Questionnaires, Community Health Nursing organization & administration, Counseling organization & administration, HIV Infections nursing, Home Care Services organization & administration, Palliative Care organization & administration
- Abstract
The study was aimed at exploring the realization of counseling, palliative care, and terminal care in the care of people with HIV/AIDS in seven settings in South Africa. A descriptive study was performed in seven sites where a model of home-based care was implemented that links hospitals, clinics, and home-based care in a continuum. Data was collected from people with HIV/AIDS (PWA), their caretakers, health care workers, and community members using semistructured interviews, observation, taping of onsite meetings, and completion of questionnaires. Descriptive and nonparametric statistics were used to analyze the quantitative data, and the template approach was used to analyze the qualitative data. There is a need to extend counseling before and after diagnostic testing to counseling about living with HIV/AIDS. There is also a need to equip counselors to deal with children. Fifty-seven percent of patients died at home or in hospice. There is a significant relationship between a "good" death and dying at home. Palliative care in the formal health services was generally poor due mainly to lack of specific training in this field and the stigma associated with this diagnosis. Health care providers can change the experience of illness and death for PWA through adequate counseling, palliative care, and terminal care that meet professional standards. more...
- Published
- 2003
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14. Ovarian germ cell malignancy and human immunodeficiency virus (HIV) infection: a case report.
- Author
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Moodley M and Moodley J
- Subjects
- Adolescent, Biopsy, Needle, Chemotherapy, Adjuvant, Combined Modality Therapy, Female, Follow-Up Studies, Germinoma pathology, HIV Infections diagnosis, HIV Infections drug therapy, Humans, Immunohistochemistry, Ovarian Neoplasms pathology, Ovariectomy methods, Radiotherapy, Adjuvant, Risk Assessment, Treatment Outcome, Germinoma complications, Germinoma therapy, HIV Infections complications, Ovarian Neoplasms complications, Ovarian Neoplasms therapy
- Abstract
The occurrence of germ cell tumors in patients with human immunodeficiency virus (HIV) infection has not been previously reported. However, with the HIV pandemic in certain parts of the world, this association has become a reality. The approach to management as well as the role of adjuvant radiotherapy and chemotherapy is problematic as many of these therapies are toxic. The appropriate management of such tumors will remain elusive for sometime. The presentation, management, and outcome of ovarian endodermal sinus tumor in a HIV-infected patient is reported. more...
- Published
- 2003
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15. Through a glass, darkly: data and uncertainty in the AIDS debate.
- Author
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Whiteside A, Barnett T, George G, and Van Niekerk AA
- Subjects
- Africa, Southern, Humans, Life Expectancy trends, Mortality trends, Social Change, Social Responsibility, Acquired Immunodeficiency Syndrome epidemiology, HIV Infections epidemiology, Public Policy
- Abstract
The HIV/AIDS epidemic is the greatest threat to development in much of Africa. It is already the main cause of death in many countries, especially those in Southern Africa. However there is an absence of solid data on the scale and scope of the disease and how it is evolving. In this article we discuss the data on the epidemic--where it comes from and how it is presented. We note the limitations of the use of antenatal clinic surveys--which provide the bulk of our information. We then turn to the evidence of impact. The paper shows that the long incubation period between infection and illness means that it takes time for HIV infections to turn into AIDS cases, and AIDS cases to translate into deaths with all the consequences of orphaning, poverty and changing population structures. Furthermore it means that once the HIV prevalence has peaked, AIDS impact will take years to work through--this epidemic is a 'long-wave' event. The paper is premised on the view that HIV causes AIDS and AIDS causes death. It notes that insufficient and/or unreliable data have allowed leaderships to deny the scope and scale of the problem and that this is unacceptable. However it is incumbent on all to accept the moral responsibility for and the moral consequences of their work, and this includes those who gather, interpret and use the data. more...
- Published
- 2003
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16. Breast-feeding and HIV transmission: the jury is still out.
- Author
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Coutsoudis A and Rollins N
- Subjects
- Female, Humans, Infant, Infant, Newborn, Infections, Infectious Disease Transmission, Vertical, Maternal Mortality, Milk, Human virology, Risk Factors, Time Factors, Viral Load, Breast Feeding, HIV Infections transmission
- Published
- 2003
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17. Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: a case report.
- Author
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Moodley M and Moodley J
- Subjects
- Adult, Anti-HIV Agents administration & dosage, Antimetabolites, Antineoplastic administration & dosage, CD4 Lymphocyte Count, Drug Administration Schedule, Female, HIV Infections complications, Humans, Hydatidiform Mole complications, Hydatidiform Mole pathology, Hydatidiform Mole surgery, Lamivudine administration & dosage, Lamivudine therapeutic use, Methotrexate administration & dosage, Pregnancy, Uterine Neoplasms complications, Uterine Neoplasms pathology, Uterine Neoplasms surgery, Zidovudine administration & dosage, Zidovudine therapeutic use, Anti-HIV Agents therapeutic use, Antimetabolites, Antineoplastic therapeutic use, HIV Infections drug therapy, Hydatidiform Mole drug therapy, Methotrexate therapeutic use, Uterine Neoplasms drug therapy
- Abstract
Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum betaHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity. more...
- Published
- 2003
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18. A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1.
- Author
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Moodley D, Moodley J, Coovadia H, Gray G, McIntyre J, Hofmyer J, Nikodem C, Hall D, Gigliotti M, Robinson P, Boshoff L, and Sullivan JL
- Subjects
- Adult, Anti-HIV Agents administration & dosage, Delivery, Obstetric, Drug Therapy, Combination, Female, HIV Infections drug therapy, HIV Infections prevention & control, Humans, Infant, Infant, Newborn, Labor, Obstetric, Lamivudine administration & dosage, Lamivudine therapeutic use, Nevirapine administration & dosage, Nevirapine therapeutic use, Pregnancy, Pregnancy Complications, Infectious virology, Reverse Transcriptase Inhibitors administration & dosage, Treatment Outcome, Zidovudine administration & dosage, Zidovudine therapeutic use, Anti-HIV Agents therapeutic use, HIV Infections transmission, HIV-1 drug effects, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious drug therapy, Reverse Transcriptase Inhibitors therapeutic use
- Abstract
To determine the efficacy and safety of 2 inexpensive and easily deliverable antiretroviral (ARV) regimens for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 during labor and delivery, HIV-infected pregnant women were screened at 11 maternity health institutions in South Africa and were enrolled in an open-label short course ARV regimen of either nevirapine (Nvp) or multiple-dose zidovudine and lamivudine (Zdv/3TC). The overall estimated HIV-1 infection rates in 1307 infants by 8 weeks were 12.3% (95% confidence interval [CI], 9.7-15.0) for Nvp and 9.3% (95% CI, 7.0-11.6) for Zdv/3TC (P=.11). Excluding infections detected within 72 h (intrauterine), new HIV-1 infections were detected in 5.7% (95% CI, 3.7-7.8) and 3.6% (95% CI, 2.0-5.3) of infants in the Nvp and Zdv/3TC groups, respectively, in the 8 weeks after birth. There were no drug-related maternal or pediatric serious adverse events. Common complications were obstetrical for mothers (Nvp group, 24.3%; Zdv/3TC group, 26.3%) and respiratory for infants (Nvp group, 16.1%; Zdv/3TC group, 17.0%). This study further confirms the efficacy and safety of short-course ARV regimens in reducing MTCT rates in developing countries. more...
- Published
- 2003
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19. Association between HIV-1 infection, the etiology of genital ulcer disease, and response to syndromic management.
- Author
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Moodley P, Sturm PD, Vanmali T, Wilkinson D, Connolly C, and Sturm AW
- Subjects
- Adolescent, Adult, Anti-Infective Agents administration & dosage, Anti-Infective Agents therapeutic use, Cohort Studies, Drug Therapy, Combination, Erythromycin administration & dosage, Erythromycin therapeutic use, Female, Genital Diseases, Female drug therapy, Genital Diseases, Male drug therapy, HIV Infections etiology, Humans, Logistic Models, Male, Middle Aged, Penicillins administration & dosage, Penicillins therapeutic use, Prevalence, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases etiology, South Africa epidemiology, Surveys and Questionnaires, Syndrome, Ulcer drug therapy, Genital Diseases, Female virology, Genital Diseases, Male virology, HIV Infections epidemiology, HIV-1, Ulcer virology
- Abstract
Background: Reports on the effect of HIV-1 infection on healing rates of ulcers are conflicting., Goal: The goal was to determine the etiology and response to treatment of genital ulcer disease (GUD) in relation to HIV-1 infection., Study Design: This was a cohort study of patients with GUD treated with local syndromic management protocols., Results: Among the 587 recruited, the prevalences of infections due to HSV, Treponema pallidum, Chlamydia trachomatis (lymphogranuloma venereum [LGV]), Haemophilus ducreyi, Calymmatobacterium granulomatis, and HIV-1 were 48%, 14%, 11%, 10%, 1%, and 75%, respectively. The prevalence T. pallidum of was higher among men (P = 0.03), and an association was seen among HIV-1-seronegatives on univariate and multivariate analyses (P < 0.001; = 0.01). The prevalence of C trachomatis (LGV) was higher among females (P = 0.004), and an association was seen among HIV-1-seropositives on univariate analysis (P = 0.04). At follow-up, 40/407 (10%) showed a decreased healing tendency, not associated with ulcer etiology or HIV-1 seropositivity., Conclusion: Response to syndromic management of GUD was acceptable and not associated with HIV-1 coinfection. more...
- Published
- 2003
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20. Molecular characteristics of human immunodeficiency virus type 1 subtype C viruses from KwaZulu-Natal, South Africa: implications for vaccine and antiretroviral control strategies.
- Author
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Gordon M, De Oliveira T, Bishop K, Coovadia HM, Madurai L, Engelbrecht S, Janse van Rensburg E, Mosam A, Smith A, and Cassol S
- Subjects
- AIDS Vaccines, Adult, Amino Acid Sequence, Amino Acid Substitution, Anti-HIV Agents pharmacology, Drug Resistance, Viral genetics, Female, Genes, env genetics, HIV Infections drug therapy, HIV Infections prevention & control, HIV Protease chemistry, HIV Protease genetics, HIV Reverse Transcriptase chemistry, HIV Reverse Transcriptase genetics, HIV-1 drug effects, Humans, Infant, Male, Molecular Sequence Data, Sequence Analysis, DNA, South Africa, Genetic Variation, HIV Infections virology, HIV-1 classification, HIV-1 genetics, Phylogeny
- Abstract
The KwaZulu-Natal region of South Africa is experiencing an explosive outbreak of human immunodeficiency virus type 1 (HIV-1) subtype C infections. Understanding the genetic diversity of C viruses and the biological consequences of this diversity is important for the design of effective control strategies. We analyzed the protease gene, the first 935 nucleotides of reverse transcriptase, and the C2V5 envelope region of a representative set of 72 treatment-naïve patients from KwaZulu-Natal and correlated the results with amino acid signature and resistance patterns. Phylogenetic analysis revealed multiple clusters or "lineages" of HIV-1 subtype C that segregated with other C viruses from southern Africa. The same pattern was observed for both black and Indian subgroups and for retrospective specimens collected prior to 1990, indicating that multiple sublineages of HIV-1 C have been present in KwaZulu-Natal since the early stages of the epidemic. With the exception of three nonnucleoside reverse transcriptase inhibitor mutations, no primary resistance mutations were identified. Numerous accessory polymorphisms were present in the protease, but none were located at drug-binding or active sites of the enzyme. One frequent polymorphism, I93L, was located near the protease/reverse transcriptase cleavage site. In the envelope, disruption of the glycosylation motif at the beginning of V3 was associated with the presence of an extra protein kinase C phosphorylation site at codon 11. Many polymorphisms were embedded within cytotoxic T lymphocyte or overlapping cytotoxic T-lymphocyte/T-helper epitopes, as defined for subtype B. This work forms a baseline for future studies aimed at understanding the impact of genetic diversity on vaccine efficacy and on natural susceptibility to antiretroviral drugs. more...
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- 2003
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- View/download PDF
21. Rape survivors and the right to emergency medical treatment to prevent HIV infection.
- Author
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McQuoid-Mason D, Dhai A, and Moodley J
- Subjects
- Female, Hospitals, Private legislation & jurisprudence, Hospitals, State legislation & jurisprudence, Humans, Organizations legislation & jurisprudence, Physician's Role, Police legislation & jurisprudence, Refusal to Treat legislation & jurisprudence, South Africa, Emergency Medical Services legislation & jurisprudence, HIV Infections etiology, HIV Infections prevention & control, Patient Rights legislation & jurisprudence, Rape legislation & jurisprudence, Survivors legislation & jurisprudence
- Published
- 2003
22. Influence of HIV-1 coinfection on effective management of abnormal vaginal discharge.
- Author
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Moodley P, Wilkinson D, Connolly C, and Sturm AW
- Subjects
- Adolescent, Adult, Animals, Anti-Bacterial Agents, Chlamydia trachomatis isolation & purification, Ciprofloxacin administration & dosage, Cohort Studies, Doxycycline administration & dosage, Drug Administration Schedule, Drug Therapy, Combination, Female, Humans, Metronidazole administration & dosage, Middle Aged, Neisseria gonorrhoeae isolation & purification, Prevalence, South Africa epidemiology, Treatment Outcome, Trichomonas vaginalis isolation & purification, Vaginitis microbiology, Vaginitis parasitology, Anti-Infective Agents administration & dosage, HIV Infections, HIV-1, Vaginitis drug therapy, Vaginitis epidemiology
- Abstract
Background: Reports on microbiologic cure rates following syndromic management (SM) of women with nonulcerative sexually transmitted infections (STIs) are limited., Goal: The goal of the study was to determine the effectiveness of the drugs used in SM of nonulcerative STIs and bacterial vaginosis in women and to compare the response among those with and without HIV-1 coinfection., Study Design: This was a cohort study of women with nonulcerative STIs who were treated according to local SM protocols., Results: Of 692 women recruited, 415 (80%) returned 8 to 10 days later, and 290 (70%) consented to a second examination, in which specimens were obtained. Clinical cure was reported by 67%, and microbiologic cure ranged from 80% to 89% for the three discharge-causing STIs and was independent of HIV-1 status. Only 38% of those with bacterial vaginosis were cured, and HIV-1-infected women were less likely to be cured (28% versus 52%; P < 0.001)., Conclusions: Clinical and microbiologic response to SM of the nonulcerative STIs was not affected by HIV-1 coinfection, but cure rates for bacterial vaginosis were reduced. more...
- Published
- 2003
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- View/download PDF
23. Breastfeeding and risk of HIV transmission: an update.
- Author
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Coutsoudis A
- Subjects
- Adult, Developing Countries, Female, Guidelines as Topic, Humans, Infant, Infant Formula administration & dosage, Infant, Newborn, Milk, Human virology, Breast Feeding adverse effects, HIV Infections transmission, Infant Nutritional Physiological Phenomena, Infectious Disease Transmission, Vertical prevention & control
- Published
- 2003
24. Conference misses the point: orphans and other vulnerable children in the age of HIV/AIDS.
- Author
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Franklin L
- Subjects
- Acquired Immunodeficiency Syndrome transmission, Africa South of the Sahara epidemiology, Child, Child of Impaired Parents, Child, Abandoned, Child, Preschool, Congresses as Topic, Delivery of Health Care standards, Developing Countries, Family Health, Female, HIV Seroprevalence, Humans, Infectious Disease Transmission, Vertical prevention & control, Pregnancy, Socioeconomic Factors, Survival Rate, Acquired Immunodeficiency Syndrome epidemiology, Child Welfare, Foster Home Care statistics & numerical data, HIV Infections epidemiology
- Published
- 2002
25. Colour Doppler and grey scale ultrasound features of HIV-related vascular aneurysms.
- Author
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Woolgar JD, Ray R, Maharaj K, and Robbs JV
- Subjects
- Adult, Aneurysm, False diagnostic imaging, Aneurysm, False virology, Carotid-Cavernous Sinus Fistula diagnostic imaging, Carotid-Cavernous Sinus Fistula virology, Female, Femoral Artery diagnostic imaging, Humans, Male, Middle Aged, Retrospective Studies, Ultrasonography, Doppler, Color, Aneurysm diagnostic imaging, Aneurysm virology, HIV Infections complications
- Abstract
Atypical aneurysms of large elastic arteries owing to human immunodeficiency virus (HIV) vasculopathy are a well described complication of acquired immunodeficiency syndrome (AIDS). However, there are no reports describing the ultrasound features of these lesions. We performed a retrospective review of ultrasound images of 12 patients presenting with 39 HIV-related aneurysms over a 2 year period. Of these there were a total of 12 patients with symptomatic lesions comprising the superficial femoral artery (n=5), the origin of the internal carotid artery (n=3), the popliteal artery (n=2), the common femoral artery (n=1) and the common iliac artery (n=1). The remainder were asymptomatic and were demonstrated radiologically. The ultrasound features of large symptomatic HIV-related femoral and carotid aneurysms were typical of pseudoaneurysms with a defect or "blow-out" in the vessel wall and turbulent pulsatile flow. Of note was the presence of marked thickening of the vessel adjacent to the aneurysm and hyperechoic "spotting" of the arterial wall. These ultrasound features described may be unique to HIV vasculopathy. more...
- Published
- 2002
- Full Text
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26. Evaluation of a rapid human immunodeficiency virus test at two community clinics in Kwazulu-Natal.
- Author
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Phili R and Vardas E
- Subjects
- AIDS Serodiagnosis economics, AIDS Serodiagnosis standards, Analysis of Variance, Chi-Square Distribution, Enzyme-Linked Immunosorbent Assay economics, Enzyme-Linked Immunosorbent Assay standards, Female, HIV Infections blood, HIV Infections epidemiology, HIV Seroprevalence, Humans, Mass Screening economics, Mass Screening standards, Pilot Projects, Pregnancy, Pregnancy Complications, Infectious blood, Pregnancy Complications, Infectious epidemiology, Primary Health Care, Prospective Studies, Sensitivity and Specificity, South Africa epidemiology, Time Factors, AIDS Serodiagnosis methods, Enzyme-Linked Immunosorbent Assay methods, HIV Infections diagnosis, Mass Screening methods, Pregnancy Complications, Infectious diagnosis
- Abstract
Objectives: To establish whether the Determine (Abbott, Tokyo, Japan) HIV antibody test is suitable as an on-site rapid HIV test at primary health care centres by determining its sensitivity and specificity compared with the standard enzyme-linked immunoassay (ELISA) test., Design: Prospective field evaluation study of a rapid HIV test compared with an ELISA., Setting: KwaDabeka clinic and St Mary's Hospital, urban primary health care clinics in the Durban western metropolitan area., Subjects: Women attending antenatal clinics and those presenting at onset of labour., Outcome Measures: Performance of the rapid test versus conventional ELISA testing, sensitivity, specificity, feasibility of implementing the test at primary health care clinics, prevalence of HIV infection at study sites and its association with patient booking status., Results: A total of 323 specimens were tested from patients from two community clinics, KwaDabeka (N = 159) and St Mary's (N = 164). The overall HIV prevalence was 45.5%. There was a significant difference in HIV prevalence (P < 0.001) between KwaDabeka (35.2%) and St Mary's (55.5%). Of the participants 49.2% were from KwaDabeka clinic and 50.8% from St Mary's Hospital. Overall, HIV prevalence among unbooked participants was 43.0%, and among booked participants 46.3%. This was not statistically different (P = 0.612) between the two clinics. The rapid test showed a sensitivity and specificity of 100% when compared with a conventional diagnostic ELISA test., Conclusion: The Determine rapid HIV antibody test is sensitive, specific, easy to perform and provides a valuable method for HIV testing especially in settings with limited access to laboratory infrastructures and trained laboratory staff. more...
- Published
- 2002
27. Impact of HIV-1 co-infection on presentation and hospital-related mortality in children with culture proven pulmonary tuberculosis in Durban, South Africa.
- Author
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Jeena PM, Pillay P, Pillay T, and Coovadia HM
- Subjects
- Case-Control Studies, Child, Child, Preschool, Female, Hospital Mortality, Humans, Infant, Male, Prevalence, Retrospective Studies, South Africa epidemiology, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary mortality, AIDS-Related Opportunistic Infections complications, HIV Infections complications, HIV-1, Tuberculosis, Pulmonary complications
- Abstract
Background: Diagnosis of tuberculosis (TB) in childhood is difficult and is compounded by HIV-1, as both diseases often co-exist and have many similar features. Most studies from developing countries have included subjects in whom the diagnosis of TB is suspected but not proven. We therefore compare the findings in HIV-infected and non-HIV-infected children with culture-proven TB., Methods: Records were obtained from the laboratory at King Edward VIII Hospital, Durban, South Africa, between January 1998 and December 1999. Children aged 0-12 years with proven pulmonary tuberculosis (sputum, gastric washing or endotracheal aspirate culture for Mycobacterium tuberculosis) from the paediatric medical wards and intensive care unit were included in the study. A retrospective chart review of demographic data, clinical presentation, diagnostic modalities for TB, HIV-1 result, management and outcome were evaluated., Results: Of 138 culture-proven cases of TB identified during the study period, the medical records of 118 (86%) could be traced. Of these, 57 (48%) were HIV-1 infected, 44 (37%) non-HIV-1-infected, and in 17 (14%) HIV-1 status was not determined. In contrast to previous studies, this study has shown that TB-HIV co-infection in children is common (48% of all culture-proven cases), the presentation of tuberculosis may be acute (43%), and supportive tests are individually only reliable in confirming a diagnosis in a third of cases. All culture evaluations for M. tuberculosis were positive by 8 weeks. Where other diseases often co-exist with TB and HIV infection and the pressure for hospital in-patient admissions are excessive, the diagnosis of tuberculosis could easily be missed (21.2%). Clubbing and age over 2 years were the most reliable indicators of underlying HIV-1 disease in a child with tuberculosis, while clinical features, radiology and supportive tests were found to be similar between HIV-infected and non-HIV-infected TB cases. Hospital-related mortality, all causes, was higher (17.5%) in the HIV-1-infected than the non-infected group (11.4%)., Conclusion: The changing pattern of presentation of childhood tuberculosis and the high prevalence of TB in HIV endemic areas has made it imperative to maintain a high index of suspicion, with culture evaluation being an important part of clinical practice. more...
- Published
- 2002
28. Free formula milk for infants of HIV-infected women: blessing or curse?
- Author
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Coutsoudis A, Goga AE, Rollins N, and Coovadia HM
- Subjects
- Acquired Immunodeficiency Syndrome prevention & control, Acquired Immunodeficiency Syndrome transmission, Adult, Africa South of the Sahara epidemiology, Anti-HIV Agents administration & dosage, Anti-HIV Agents therapeutic use, Developing Countries, Female, HIV Infections epidemiology, Humans, Infant, Infant Food supply & distribution, Infant, Newborn, Milk, Human virology, Pregnancy, Risk Assessment, Risk Factors, Bottle Feeding adverse effects, Breast Feeding adverse effects, HIV Infections prevention & control, HIV Infections transmission, Health Policy, Health Promotion economics, Infant Food economics, Infectious Disease Transmission, Vertical prevention & control
- Abstract
There is vigorous controversy around whether HIV-infected women in developing countries should choose formula or breastfeeding for their infants. Formula eliminates HIV transmission but incurs risk of increased mortality, whereas breastfeeding has multiple benefits but entails risk of HIV transmission. International guidelines are available but need to be strengthened. This commentary summarizes data on the scale and rate of mother-to-child transmission (MTCT) of HIV through breastfeeding, and the hazards and benefits of breast- and formula-feeding. The case against providing free or subsidized formula to HIV-infected mothers is based on the following: it exacerbates disadvantages of formula feeding; compromises free choice; targets beneficiaries erroneously; creates a false perception of endorsement by health workers; compromises breastfeeding; results in disclosure of HIV status; ignores hidden costs of preparation of formula; increases mixed breastfeeding, which is an unsatisfactory method for all women; requires organization and management of programmes that are complicated and costly; and finally increases the 'spill-over' effect into the normal breastfeeding population. Recommendations to minimize these drawbacks include use of affordable antiretrovirals to reduce MTCT; investments in high-quality, widely available HIV counselling; support for choice of feeding; and exclusive breastfeeding for those who choose to breastfeed. more...
- Published
- 2002
- Full Text
- View/download PDF
29. The HIV/AIDS epidemic in Africa: implications for U.S. policy.
- Author
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Gow J
- Subjects
- Acquired Immunodeficiency Syndrome economics, Acquired Immunodeficiency Syndrome epidemiology, Adult, Africa South of the Sahara epidemiology, Child, Disease Outbreaks economics, Financing, Government statistics & numerical data, Financing, Organized statistics & numerical data, Global Health, HIV Infections economics, Humans, Infant, Infant Mortality, Leadership, Life Expectancy, Prevalence, United States, Disease Outbreaks prevention & control, HIV Infections epidemiology, Health Policy, Politics
- Abstract
Political will or commitment toward the HIV epidemic has been lacking in most African countries. Although most countries are in denial, a few have moved into recognition of the epidemic. Only two countries, Senegal and Uganda, have moved into mobilization. Ineffectiveness is judged by increasing HIV prevalence rates and declining life expectancy. Countries without active national leadership to fight the epidemic have seen deterioration in these criteria. In addition to its toll in Africa, this epidemic threatens U.S. political, economic, and security interests. Political responses to manage the risks to the United States have revolved around much increased development assistance through traditional channels and financial support for the United Nations' Global Fund to Fight AIDS, Tuberculosis, and Malaria. more...
- Published
- 2002
- Full Text
- View/download PDF
30. Disseminated cutaneous histoplasmosis in patients infected with human immunodeficiency virus.
- Author
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K Ramdial P, Mosam A, Dlova NC, B Satar N, Aboobaker J, and Singh SM
- Subjects
- Adult, Antifungal Agents therapeutic use, Child, Preschool, Dermatomycoses drug therapy, Dermatomycoses immunology, Dermatomycoses pathology, Female, HIV Infections drug therapy, HIV Infections pathology, Histoplasma isolation & purification, Histoplasmosis drug therapy, Histoplasmosis pathology, Humans, Immunocompromised Host, Male, Prospective Studies, Dermatomycoses etiology, HIV Infections complications, Histoplasmosis etiology
- Abstract
Background: In the pre-AIDS era disseminated histoplasmosis was rare and the cutaneous manifestations thereof were reported infrequently. A range of unusual clinical manifestations of disseminated cutaneous histoplasmosis (DCH) in AIDS patients has been documented, but the cutaneous histopathological descriptions are short and incomplete. In addition, the histopathological spectrum of AIDS-associated DCH is poorly recognized., Methods: This is a prospective 32-month study of all HIV positive patients diagnosed with histoplasmosis in the Departments of Anatomical Pathology and Dermatology, Nelson R. Mandela School of Medicine and King Edward VIII Hospital, Durban, South Africa. Clinical distribution and morphology of the individual skin lesions and CD4+ lymphocyte counts in the peripheral blood were analysed in relation to the histopathological features of biopsied lesional tissue. Ultrastructural examination of tissue retrieved from the wax blocks of three cases that exhibited dermal karyorrhexis and collagen necrosis was undertaken. Fungal culture of lesional skin tissue was undertaken in all patients., Results: Twenty-one biopsies of papules (7), nodules (4), plaques (5), erythema multiforme-like lesions (2), vasculitic lesions (2) and exfoliative dermatitis (1) from 14 patients were examined. Of four biopsies (CD4 range: 120-128 cells/mm3) one and three demonstrated necrotizing and non-necrotizing granulomatous inflammation with a paucity of intrahistiocytic microorganisms. Seven biopsies (CD4 range: 2-56 cells/mm3) demonstrated diffuse dermal and intravascular accumulation of histiocytes densely parasitized by Histoplasma capsulatum var. capsulatum. Vasculitis, karyorrhexis or collagen necrosis was not present. Ten biopsies (CD4 range: 2-72 cells/mm3) demonstrated diffuse dermal karyorrhexis, collagen necrosis and interstitial, extracellular H. capsulatum var. capsulatum. Histiocytic disintegration and nuclear fragmentation and release of intact microorganisms and intact and ruptured lysosomes were identified ultrastructurally. Leucocytoclastic vasculitis was present in two biopsies of vasculitic clinical morphology. Microbiological culture confirmed histoplasmosis in all cases. Three patients died before treatment was commenced. Two patients died within the first two days of induction of therapy. Nine patients demonstrated dramatic healing of the cutaneous lesions., Conclusions: Despite the clinicopathological spectrum of DCH and the attendant host immunocompromise, timely and appropriate treatment of DCH may be lifesaving and allows rapid healing of skin lesions. A high index of clinical suspicion and skin biopsies and culture are crucial for accurate diagnosis. more...
- Published
- 2002
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31. Vertical HIV transmission in South Africa: translating research into policy and practice.
- Author
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Abdool Karim S, Abdool Karim Q, Adhikari M, Cassol S, Chersich M, Cooper P, Coovadia A, Coovadia H, Cotton M, Coutsoudis A, Hide W, Hussey G, Maartens G, Madhi S, Martin D, Pettifor JM, Rollins N, Sherman G, Thula S, Urban M, Velaphi S, and Williamson C more...
- Subjects
- Anti-HIV Agents therapeutic use, Breast Feeding, Developing Countries, Female, Humans, Infant, Infant, Newborn, Nevirapine therapeutic use, South Africa, HIV Infections prevention & control, Infectious Disease Transmission, Vertical prevention & control
- Published
- 2002
- Full Text
- View/download PDF
32. Stage of the epidemic and viral phenotype should influence recommendations regarding mother-to-child transmission of HIV-1.
- Author
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Hudson CP, Moodley J, and Smith AN
- Subjects
- Breast Feeding, Disease Outbreaks, Female, HIV Infections epidemiology, HIV Infections prevention & control, Humans, Infant, Infant, Newborn, Nevirapine therapeutic use, Phenotype, Pregnancy, Pregnancy Complications, Infectious epidemiology, Risk Factors, Virulence, Zidovudine therapeutic use, Anti-HIV Agents therapeutic use, HIV Infections transmission, HIV-1 genetics, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious prevention & control
- Abstract
This article argues for a new approach to use of nevirapine in the prevention of vertical transmission of HIV-1. Existing antenatal surveillance should be strengthened to plan geographical allocation, and subsequent evaluation, of a "nevirapine plus" programme. As the epidemic evolves the programme should also and, ideally, care should be tailored to individual women. Underpinning this approach is evidence that a more virulent viral phenotype appears in many patients with advanced HIV-1 infection. This phenotype will become more common at the population level as the epidemic progresses. As efficacy of zidovudine correlates with viral phenotype, and use of the drug may alter phenotype, there is an urgent need for a replacement that is safe to use with nevirapine. more...
- Published
- 2002
- Full Text
- View/download PDF
33. The evolving HIV epidemic in South Africa.
- Author
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Abdool-Karim Q and Abdool-Karim SS
- Subjects
- Adolescent, Adult, Culture, Female, Humans, Incidence, Male, Middle Aged, Prevalence, South Africa epidemiology, Disease Outbreaks, HIV Infections epidemiology
- Published
- 2002
- Full Text
- View/download PDF
34. Interrelationships among human immunodeficiency virus type 1 infection, bacterial vaginosis, trichomoniasis, and the presence of yeasts.
- Author
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Moodley P, Connolly C, and Sturm AW
- Subjects
- Adolescent, Adult, Aged, Candidiasis, Vulvovaginal epidemiology, Female, HIV Infections epidemiology, Humans, Middle Aged, South Africa, Trichomonas Vaginitis epidemiology, Vaginal Discharge epidemiology, Vaginosis, Bacterial epidemiology, Women's Health, Candidiasis, Vulvovaginal complications, HIV, HIV Infections complications, Sexually Transmitted Diseases epidemiology, Trichomonas Vaginitis complications, Vaginosis, Bacterial complications
- Abstract
Vaginal discharge of mixed etiology occurs frequently, with abnormal vaginal flora being the most common condition. The interrelationships among the disturbance of the vaginal ecology, the presence of yeasts, and infection with Trichomonas vaginalis and human immunodeficiency virus type 1 (HIV-1) were investigated among women presenting to a sexually transmitted diseases service. Analysis was done for 598 women. Although the prevalence of HIV-1 infection increased linearly with increasing Nugent's score (bacterial vaginosis score of Gram stain), the prevalence of T. vaginalis increased suddenly, from 12% in patients with a Nugent's score of < or =3 to 33% in patients with a score of 4, and remained at this level at higher scores. Yeast colonization and vulvovaginal candidiasis were inversely related to Nugent's scores. T. vaginalis might be responsible for the change in normal vaginal flora and may, therefore, be one of the causes of bacterial vaginosis. This could lead to more effective HIV-1 acquisition. more...
- Published
- 2002
- Full Text
- View/download PDF
35. The practice of community caregivers in a home-based HIV/AIDS project in South Africa.
- Author
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Uys LR
- Subjects
- Adult, Caregivers, Female, Hospices, Humans, Male, Middle Aged, Palliative Care, South Africa, Acquired Immunodeficiency Syndrome nursing, Community Health Nursing, Community Networks, Developing Countries, HIV Infections nursing, Home Nursing
- Abstract
The aim of this study was to describe the practice of community caregivers in a home-based AIDS care project at seven sites in South Africa. The community caregivers felt positive about the contribution they made, but found it difficult to cope with the poverty and complexity of problems they were faced with. They visited each client an average of five times per month, and their care usually involved counselling and informing, symptom control, psychosocial support and welfare assistance. The caregivers worked in close collaboration with the South African Hospice Association and clinic staff, and each site developed a work pattern suitable to its resources. more...
- Published
- 2002
- Full Text
- View/download PDF
36. Virginity testing: managing sexuality in a maturing HIV/AIDS epidemic.
- Author
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Leclerc-Madlala S
- Subjects
- Acquired Immunodeficiency Syndrome ethnology, Acquired Immunodeficiency Syndrome prevention & control, Adolescent, Adult, Child, Child, Preschool, Family ethnology, Female, Foster Home Care, HIV Infections prevention & control, Humans, Social Control, Formal, South Africa epidemiology, Attitude to Health ethnology, Communicable Disease Control methods, Gender Identity, HIV Infections ethnology, Sexual Abstinence, Women
- Abstract
KwaZulu-Natal province in South Africa is currently the site of the world's fastest growing HIV/AIDS epidemic, where it is estimated that between 30 and 40 percent of the adult population is seropositive for HIV. With support from local politicians and members of various government ministries, several self-styled guardians of tradition have emerged to form organizations that advocate and conduct regular virginity testing of girls. Reference to the current HIV/AIDS epidemic is central to calls for greater support of this practice. Drawing on original research among Zulu-speaking people in the periurban communities of Durban, this article examines the sociocultural construction of HIV/AIDS and locates the growing popularity of virginity testing within a gendered meaning-making process consistent with commonly held beliefs that the epidemic is the result of women being sexually "out of control." With the social impact of AIDS starting to take its toll in the forms of increasing AIDS-related deaths and a growing population of orphans, I argue that virginity testing is an attempt to manage the epidemic by exerting greater control over women and their sexuality. In addition, virginity testing of girls helps to draw attention away from the role of men in the maturing epidemic, consideration of which has been conspicuously absent in the popular discourse on AIDS at all levels of South African society. more...
- Published
- 2001
- Full Text
- View/download PDF
37. Obstacles to negotiating dual protection: perspectives of men and women.
- Author
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Maharaj P
- Subjects
- Adolescent, Adult, Female, Focus Groups, HIV Infections transmission, Humans, Male, Pregnancy, Sexual Partners, South Africa, Condoms statistics & numerical data, HIV Infections prevention & control, Health Knowledge, Attitudes, Practice, Negotiating, Pregnancy, Unwanted statistics & numerical data
- Abstract
This article presents findings from a qualitative study on the perspectives of sexually active men and women about the risks of unwanted pregnancy and HIV/AIDS. The study found that there is a high level of awareness of the risk of unwanted pregnancy and HIV/AIDS. Knowledge of condoms as a method of preventing pregnancy and HIV/AIDS is also relatively good. However, there are many real and perceived barriers to condom use especially in stable sexual relationships. In stable long-term relationships, resistance to condom use was found to be strongly related to its association with STIs (including HIV/AIDS). Men and women do not see the need for condoms in stable, ongoing sexual relationships if a more effective method is used for pregnancy prevention. Condom use in such relationships may be seen as a clear sign of infidelity. These attitudes represent a major obstacle to the use of condoms as a dual method of protection. more...
- Published
- 2001
38. Efficacy and cost-effectiveness of bronchial arterial embolisation in the treatment of major haemoptysis.
- Author
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Corr P, Blyth D, Sanyika C, and Royston D
- Subjects
- Adult, Cost-Benefit Analysis, Embolization, Therapeutic economics, Female, Humans, Male, Pneumonectomy, Retrospective Studies, Treatment Outcome, Bronchial Arteries, Embolization, Therapeutic methods, HIV Infections complications, Hemoptysis therapy, Pneumonia complications
- Abstract
Objective: To determine the efficacy and cost-effectiveness of bronchial artery embolisation (BAE) in the treatment of major and massive haemoptysis in HIV-positive and negative patients with pulmonary inflammatory disease., Methods: A retrospective review of patients admitted over a period of 24 months to Wentworth Hospital with major haemoptysis treated using BAE., Results: Eighty-seven patients were treated (77 males, 10 females). Bilateral disease was present in 50 patients (57%). Thirty-two patients were HIV-positive (37%). Embolisation was successfully performed in 77 patients (88.5%), and failed for technical reasons in 10 patients (11.5%). There was only one procedural complication. Fifty-seven patients had a successful outcome, with cessation of haemoptysis within 24 hours (66.5%). Haemoptysis continued in 30 patients (34%) (20 patients embolised and the 10 patients who had failed procedures). Fourteen of these patients (16%) required lobectomy or pneumonectomy as an emergency procedure. Five patients (5.7%) died from respiratory failure or pulmonary haemorrhage. Twenty-four HIV-positive patients were successfully embolised. Costing of BAE, including a 2-day ICU and 3-day ward stay, was R6,720; together with surgical resection the cost was R14,170., Conclusions: BAE is an effective treatment for major and/or massive haemoptysis in patients with pulmonary inflammatory disease who are not surgical candidates. Patients who are HIV-positive are able to tolerate the procedure well. more...
- Published
- 2001
39. Barriers to preventing human immunodeficiency virus in women: experiences from KwaZulu-Natal, South Africa.
- Author
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Abdool Q and Karim
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Rural Health, South Africa, Surveys and Questionnaires, Urban Health, Women's Health, HIV Infections prevention & control, Health Knowledge, Attitudes, Practice, Sexual Behavior
- Abstract
Objective: to determine barriers to the adoption of safer sex practices in women in KwaZulu-Natal, South Africa., Methods: This cross-sectional survey was conducted in a peri-urban and a rural community in 1991 to 1993. A structured, pretested questionnaire was administered to consenting women age 15 to 44 years who had been drawn randomly from a 10% systematic sample of households. The questionnaire included the following items: demographic characteristics, sexual relationships, knowledge of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), perception of risk, knowledge of and skills with respect to safer sex practices, and perceptions of rights to safer sex practices., Results: A total of 219 interviews were conducted. Most respondents had an average of 8 years of schooling and were seeking employment. The majority of the respondents were sexually active (88.1%) and had extensive knowledge of modes of transmission and methods of preventing HIV/AIDS. Although most respondents underestimated their risk of HIV infection, a key reason for women not acting on their knowledge and perception of risk was that many did not believe they had a right to refuse sex with their partners (48.8%) or insist on condom use (46.1%). Most women thought their partners had a right to multiple partners (62.2%). Only 35.2% of respondents had the skills to object to their partners' having multiple partners, and 82.4% lacked the skills to use condoms., Conclusion: Women in these communities are at high risk of HIV infection. Their perceived lack of a right to safer sex, lack of skills to adopt safer sex practices, financial dependence on their sex partners, and the threat of violence influenced their ability to reduce their risk of HIV infection. more...
- Published
- 2001
40. Growth in early childhood in a cohort of children born to HIV-1-infected women from Durban, South Africa.
- Author
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Bobat R, Coovadia H, Moodley D, Coutsoudis A, and Gouws E
- Subjects
- Anthropometry, Body Height, Disease Progression, Female, Follow-Up Studies, Growth, Growth Disorders physiopathology, HIV Infections transmission, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Prognosis, Prospective Studies, Risk Factors, South Africa, Weight Gain, Developing Countries, Growth Disorders etiology, HIV Infections complications, HIV-1
- Abstract
This study describes growth in a cohort of black South African children born to HIV-1-infected women in Durban. Children born to HIV-1-seropositive women were followed up from birth to early childhood. At birth and at each visit, growth parameters were measured. Mean Z-scores were calculated for weight-for-length, weight-for-age and length-for-age and, if they were low, the children were regarded as wasted, malnourished or stunted, respectively. At the end of the study, there were 48 infected and 93 uninfected children. There were no significant differences between the two groups at birth. Thereafter, the infected group was found to have early and sustained low mean Z-scores for length-for-age and weight-for-age but not for weight-for-length. The means reached significance at ages 3, 6 and 12 months for length and at 3, 6 and 9 months for weight. Infected children who died early had more severe stunting, wasting and malnutrition than infected children who survived. Infected children born to HIV-positive women have early and sustained stunting and are malnourished but not wasted. Children with rapidly progressive disease have both stunting and wasting and are more severely affected. Early nutritional intervention might help prevent early progression or death in HIV-infected children, particularly in developing countries without access to anti-retroviral therapy in state hospitals. more...
- Published
- 2001
- Full Text
- View/download PDF
41. Models of intervention for children in difficult circumstances in South Africa.
- Author
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Sewpaul V
- Subjects
- Child, Humans, National Health Programs, Organizations, School Health Services, South Africa, Child Abuse prevention & control, Child Health Services organization & administration, HIV Infections prevention & control, Social Work organization & administration
- Abstract
Advances in policy have helped to create interventions for children in difficult circumstances in South Africa. This article examines models addressing children suffering abuse and neglect and children affected by HIV/AIDS. The focus is on innovative local attempts to deal with these problems, rather than theoretical reflection. Larger programs are usually conducted by government agencies because they have more resources but valuable solutions have also been created by NGOs. more...
- Published
- 2001
42. To test or not to test--ethical dilemmas and practical realities in the use of co-trimoxazole and nevirapine in HIV-infected adults.
- Author
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Hudson CP, Smith AN, and Moodley J
- Subjects
- Adult, Developing Countries, Female, HIV Infections transmission, Humans, Infant, Newborn, Male, Patient Education as Topic, Pregnancy, South Africa, AIDS Serodiagnosis, AIDS-Related Opportunistic Infections prevention & control, Anti-HIV Agents administration & dosage, Ethics, Medical, HIV Infections prevention & control, Infectious Disease Transmission, Vertical prevention & control, Nevirapine administration & dosage, Pregnancy Complications, Infectious prevention & control, Prenatal Care, Trimethoprim, Sulfamethoxazole Drug Combination administration & dosage
- Published
- 2001
43. Anterior spinal decompression in HIV-positive patients with tuberculosis. A prospective study.
- Author
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Govender S, Parbhoo AH, Kumar KP, and Annamalai K
- Subjects
- Adolescent, Adult, Antitubercular Agents therapeutic use, Bone Transplantation, Female, Humans, Lymphocyte Subsets, Male, Prospective Studies, Transplantation, Homologous, Decompression, Surgical, HIV Infections complications, Tuberculosis, Spinal complications, Tuberculosis, Spinal surgery
- Abstract
total of 39 HIV-infected adults with spinal tuberculosis underwent anterior spinal decompression for neurological deficit. Fresh-frozen allografts were used in 38 patients. Antituberculous drugs were prescribed for 18 months, but antiretroviral therapy was not used. Six patients died within two years of surgery. Neurological recovery and allograft incorporation were observed at follow-up at a mean of 38 months, although the CD4/CD8 ratios were reversed in all patients. Adequate preoperative nutritional support and compliance with antituberculous treatment are essential in ensuring a satisfactory outcome. more...
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- 2001
- Full Text
- View/download PDF
44. Impact of HIV-1 infection in South Africa.
- Author
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Pillay K, Colvin M, Williams R, and Coovadia HM
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, Adolescent, Candidiasis epidemiology, Candidiasis etiology, Child, Child, Preschool, Cross-Sectional Studies, Enzyme-Linked Immunosorbent Assay, HIV Infections complications, Humans, Infant, Infant, Newborn, Pneumonia epidemiology, Pneumonia etiology, Polymerase Chain Reaction, Prevalence, Prospective Studies, South Africa epidemiology, HIV Infections epidemiology, HIV-1, Hospitalization statistics & numerical data
- Abstract
In a prospective study, 60% of admissions to an academic hospital were infected with HIV. HIV infected children were younger, less likely to have been referred, more likely to have pneumonia and candidiasis, and had more health service attendances. This impact may be alleviated by appropriate primary and secondary level health care. more...
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- 2001
- Full Text
- View/download PDF
45. Choriocarcinoma and human immunodeficiency virus (HIV) infection: a case report.
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Moodley M and Moodley J
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Choriocarcinoma complications, Choriocarcinoma drug therapy, Diagnosis, Differential, Female, HIV Infections complications, Humans, Pregnancy, Uterine Hemorrhage etiology, Uterine Neoplasms complications, Uterine Neoplasms drug therapy, Choriocarcinoma diagnosis, HIV Infections diagnosis, Uterine Neoplasms diagnosis
- Abstract
The appropriate management of gynecological malignancies in human immunodeficiency virus (HIV)-infected patients is uncertain. Gestational trophoblastic disease is highly curable and occurs predominantly among young females. However, such patients are often immunocompromised and cytotoxic agents may further compromise immunity. This case report demonstrates the successful management of choriocarcinoma in a HIV-infected patient. more...
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- 2001
- Full Text
- View/download PDF
46. Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective.
- Author
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Moodley M, Moodley J, and Kleinschmidt I
- Subjects
- Adult, Age Factors, Carcinoma, Squamous Cell pathology, Female, Humans, Middle Aged, Neoplasm Staging, Prospective Studies, Seroepidemiologic Studies, South Africa epidemiology, Uterine Cervical Neoplasms pathology, Carcinoma, Squamous Cell epidemiology, HIV Infections epidemiology, Uterine Cervical Neoplasms epidemiology
- Abstract
The aim of this study was to compare the prevalence and presentation of cervical cancer in HIV-positive and HIV-negative women in our local population. Six hundred and seventy-two patients with cervical cancer presented to the gynecology oncology unit of King Edward VIII Hospital, South Africa. The HIV seroprevalence among these patients was 21%. There was an increase in the background prevalence of HIV infection (1.6-32.5%) as well as a quadrupling in the prevalence of HIV infection among patients with invasive cervical cancer (5-21%) over a 10-year period. The mean ages of the HIV-negative patients and HIV-positive patients were 55.2 and 39.8 years, respectively. Most of the HIV-positive patients were in the 30- to 40-year-old age group (51%), whereas the majority of patients who were HIV negative were in the 50- to 60-year-old age group (36%). The majority of patients, irrespective of HIV status, were more likely to have late stage disease than early stage disease. There was an increase in HIV infection in patients with both types of background prevalence and among patients with invasive cervical cancer. The mean age of HIV-positive patients was 15 years younger than that of the HIV-negative patients. The majority of patients, irrespective of HIV status, presented with late stage disease. more...
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- 2001
- Full Text
- View/download PDF
47. Severe, rapidly progressive human immunodeficiency virus type 1 disease in newborns with coinfections.
- Author
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Pillay T, Adhikari M, Mokili J, Moodley D, Connolly C, Doorasamy T, and Coovadia HM
- Subjects
- Cytomegalovirus Infections complications, Developing Countries, HIV Infections diagnosis, HIV Infections transmission, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Prospective Studies, Syphilis complications, Tuberculosis complications, AIDS-Related Opportunistic Infections, HIV Infections congenital, HIV Infections physiopathology, HIV-1 genetics
- Abstract
Aim: To describe a severe form of rapidly progressive HIV-1 infection manifesting in the neonatal period., Method: Prospective cohort study, King Edward VIII Hospital, Durban, South Africa. HIV-1-exposed neonates with hepatosplenomegaly, lymphadenopathy or persistent pneumonia within the first 28 days of life were investigated for perinatal infections. Confirmation of neonatal HIV-1 infection, HIV-1 subtype and clinical outcomes were studied., Results: Twenty-three (72%) of 32 symptomatic HIV-1-exposed neonates recruited at a mean of 15.2 days were HIV-1-infected. HIV-1 infection was detected in 5 patients who were tested within 48 h of birth, confirming congenital infection. Congenital infection was not excluded in any case. Median neonatal viral load at recruitment was 471,932 copies/ml and median CD4 was 777 cells/mm3. The predominant clinical presentation was growth retardation and prematurity. Perinatal infections detected included: tuberculosis (8), syphilis (6) and cytomegalovirus (10). All of the neonates with perinatal tuberculosis were HIV-1-coinfected. Maternal and neonatal viral load and CD4 at recruitment were not statistically different between the groups with tuberculosis vs. other coinfections. Gag gene sequence analysis confirmed closely aligned HIV-1 subtype C in mothers and neonates. Nineteen (83%) died by 9 months, with a mean age at death of 3.5 months., Conclusions: A distinct group of HIV-1-infected babies may clinically manifest in the neonatal period with perinatal coinfections, subsequent rapidly progressive HIV-1 and early death. more...
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- 2001
- Full Text
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48. Vasculitides associated with HIV infection.
- Author
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Chetty R
- Subjects
- Central Nervous System Diseases virology, Humans, Necrosis, Polyarteritis Nodosa virology, HIV Infections complications, Vasculitis virology
- Abstract
The manifestations of human immunodeficiency virus (HIV) infection are protean and vasculitides are one of the less common but nonetheless important consequences. A wide range of vasculitides can be encountered, ranging from vasculitis resulting from specific infective agents to a non-specific vasculitis. Among the infective causes, cytomegalovirus and tuberculosis are probably the most common. A polyarteritis nodosa-like vasculitis with important differences to classic polyarteritis nodosa is also described. Hypersensitivity vasculitis resulting in several patterns of vasculitis and angiocentric immunoproliferative vasculitis are well recognised. As part of the immunocompromise caused by HIV, a granulomatous inflammation involving small arteries and veins of the brain surface and leptomeninges, termed a primary angiitis of the central nervous system, is a rare vasculitis associated with high mortality. A recently described large vessel (aorta, femorals, carotids) vasculopathy resulting in either multiple aneurysm formation or occlusive disease is seen in young adults. An infective agent is not found but aetiologically some of these lesions might be the result of a leucocytoclastic vasculitis of vasa vasora or periadventitial vessels. A final group of non-specific vasculitides not fitting into any of the characteristic patterns described accounts for the residue of vasculitides associated with HIV. more...
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- 2001
- Full Text
- View/download PDF
49. Are HIV-infected women who breastfeed at increased risk of mortality?
- Author
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Coutsoudis A, Coovadia H, Pillay K, and Kuhn L
- Subjects
- Female, Follow-Up Studies, HIV Infections blood, HIV Infections drug therapy, HIV Infections immunology, Humans, Infant, Newborn, Maternal Mortality, Risk Factors, Vitamin A therapeutic use, Breast Feeding, HIV Infections mortality, HIV-1
- Published
- 2001
- Full Text
- View/download PDF
50. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa.
- Author
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Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, and Coovadia HM
- Subjects
- Cohort Studies, Female, HIV Infections diagnosis, HIV-1 isolation & purification, Humans, Infant, Infant, Newborn, Probability, Risk Factors, South Africa, Time Factors, Breast Feeding adverse effects, HIV Infections drug therapy, HIV Infections transmission, Infant Food, Infectious Disease Transmission, Vertical statistics & numerical data, Vitamin A therapeutic use
- Abstract
Objective: To determine the risk of HIV transmission by infant feeding modality., Design and Setting: A prospective study in two hospitals in Durban, South Africa., Participants: A total of 551 HIV-infected pregnant women enrolled in a randomized trial of vitamin A., Interventions: Women self-selected to breastfeed or formula feed after being counselled. Breastfeeders were encouraged to practice exclusive breastfeeding for 3-6 months., Main Outcome Measures: Cumulative probabilities of detecting HIV over time were estimated using Kaplan-Meier methods and were compared in three groups: 157 formula-fed (never breastfed); 118 exclusively breastfed for 3 months or more; and 276 mixed breastfed., Results: The three feeding groups did not differ in any risk factors for transmission, and the probability of detecting HIV at birth was similar. Cumulative probabilities of HIV detection remained similar among never and exclusive breastfeeders up to 6 months: 0.194 (95% CI 0.136-0.260) and 0.194 (95% CI 0.125-0.274), respectively, whereas the probabilities among mixed breastfeeders soon surpassed both groups reaching 0.261 (95% CI 0.205-0.319) by 6 months. By 15 months, the cumulative probability of HIV infection remained lower among those who exclusively breastfed for 3 months or more than among other breastfeeders (0.247 versus 0.359)., Conclusion: Infants exclusively breastfed for 3 months or more had no excess risk of HIV infection over 6 months than those never breastfed. These findings, if confirmed elsewhere, can influence public health policies on feeding choices available to HIV-infected mothers in developing countries. more...
- Published
- 2001
- Full Text
- View/download PDF
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