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Cervical shedding of cytomegalovirus (CMV) is important in transmission of CMV to exposed sexual partners and neonates. We evaluated prevalence and correlates of CMV DNA shedding in cervical secretions from a large cohort of HIV-1-seropositive women. Using polymerase chain reaction (PCR) assays, CMV DNA was detected in 183 (59%) cervical swab samples from 311 women. Cervical shedding of CMV DNA was significantly associated with shedding of HIV-1 DNA (odds ratio 1.8; 95% confidence interval 1.1-2.8). CMV shedding was also more frequent in women with Neisseria gonorrhoeae and Trichomonas vaginalis infections, but these associations were not statistically significant. Cervical shedding of CMV in HIV-1-infected women is very frequent and may reflect higher risk of transmission to sexual partners and neonates than previously appreciated.

Patients were recruited from Siriraj, Bamrasnaradura, and Central Chest Hospitals, the three major hospitals responsible for tuberculosis patients in Bangkok, Thailand, and vicinity.To evaluate a new rapid serologic test, the MycoDot test, for diagnosis of tuberculosis (TB).The study was conducted as a cross-sectional survey. A total of 594 patients were tested with the MycoDot test. This included 142 human immunodeficiency virus (HIV) seropositive patients with active TB, 144 HIV seronegative patients with active TB, 153 HIV seropositive controls, and 155 HIV seronegative controls.The sensitivity of the MycoDot test for detection of TB was 40.1% in HIV seropositive patients, compared with 63.2% in HIV seronegative patients (P0.001). If only patients with laboratory proven TB were evaluated, the sensitivity was 40.6% in seropositive and in 70.8% seronegative patients. The sensitivity of the MycoDot test was similar in TB patients with pulmonary and extra-pulmonary disease. The sensitivity of the test in patients with CD4 countsor = 200 cells/mm3 was significantly higher than in those with CD4 counts200 cells/mm3. The specificity of the test was 97.4%, and was identical in HIV seropositive and seronegative individuals.The MycoDot test had a higher sensitivity for the diagnosis of TB among HIV seronegative than HIV seropositive patients. Although the MycoDot test has a less than optimal sensitivity, the test specificity approaches 100%. It may be useful in patients with suspected TB and negative smears and in extra-pulmonary TB.

A prospective study was conducted in the Chiang Mai Sexually Transmitted Diseases Clinic to determine the frequency of HIV seroconversion among men following high risk sexual contacts and to establish risk factors for HIV infection. HIV antibodies were detected in 26 out of 150 men on the initial recruitment with a seroprevalence rate of 21%. Among 124 initial HIV negative subjects; 100, 77, 68, and 55 subjects were followed for 2, 4, 12, and 24 weeks, respectively. One subject had HIV seroconversion documented with the rate of 1.0% (1/100, 95% confidence interval [CI] = 0.03-5.4%). Logistic regression analysis found significantly independent associations of HIV prevalence with prostitute visits at least once a month (OR = 3.6, 95% CI = 1.2-10.9), and with cigarette smoking (OR = 3.5, 95% CI = 1.2-10.5). Intensive health education should be elucidated to decrease the high rate of HIV infection among this population.

To characterize the prevalence and correlates of HIV infection among drug users in southwestern China.Drug users in Longdao village, Yunnan Province underwent standardized interview and voluntary HIV serologic testing in a cross-sectional study. Analyses of potential risk and protective factors were stratified by method of drug use.Of 182 participants, 79 (43%) were HIV-1-seropositive. HIV seropositivity was found in 51 (80%) of the 64 intravenous drug users (IVDU) and 28 (24%) of the 118 who acknowledged use of drugs only by smoking [odds ratio (OR), 12.6; 95% confidence interval (CI), 5.7-28.5]. Among IVDU, reported sterilization of reusable injection equipment by boiling before intravenous drug use was associated with significant protection (adjusted OR, 0.16; 95% CI, 0.03-0.87). This protective association was also significant among the subset of IVDU who shared reusable injection equipment.HIV infection among drug users in Yunnan Province was highly correlated with intravenous drug use. The protective effect of sterilization of reusable injection equipment by boiling could be easily integrated into health education programs among IVDU in China and other rural Asian settings where reusable injection equipment is used.

The purpose of this study was to determine if Mycobacterium leprae is an opportunistic pathogen in immunosuppressed subjects with HIV infection. Ninety six leprosy patients at Infectious Diseases Hospital (IDH), Nairobi were screened for, HIV-1 antibody between January 1991 and June 1992. The patients included 15 who were diagnosed during the study period and 81 who were previously diagnosed and were on anti-leprosy treatment. Blood was screened for HIV antibody by first ELISA and double positive samples were confirmed by a second ELISA. The HIV seronegative patients were re-tested serologically every 3 months. Smears from skin slits were used to determine bacterial index and the patients were classified according to criteria described by Ridley and Jopling. The patients were re-assessed clinically monthly. The mean age of the patients was 40 years and ranged from 13 to 78 years. Forty seven percent had paucibacillary and 53% had multibacillary leprosy. The HIV seroprevalence was 8% in previously diagnosed patients and zero in the newly diagnosed patients. There were no changes in clinical spectrum in HIV seropositive patients during follow up period; neither reversal reactions nor erythema nodosum leprosum were observed. The study suggests that M. leprae may not be an opportunistic pathogen in immunosuppressed subjects with HIV infection.

Three hundred and thirty seven truck drivers, in transit from Mombasa to destinations within east and central Africa were interviewed on their knowledge on AIDS and sex practices using a pre-defined questionnaire. Nearly all of them, 99% (3.7/321), had heard of AIDS through mass media and from friends. When asked for a definition of AIDS, 87% (336/485 responses) described it as a sexually transmitted disease (STD) which causes body wasting and death. The majority were aware of the correct risk reducing behaviours: 76% (228/300) knew that use of condoms can prevent the transmission/acquisition of STDs but only 32% (90/295) had ever used them. This was in spite of the fact that 61% (226/309) admitted to visiting prostitutes. Various reasons were given for not using condoms. About 32% (34/188) claimed that they did not sleep with prostitutes while 18% (34/188) did not see the need for using condoms. Condoms were unavailable to another 18% (34/188). The data obtained show a clear lack of correlation between the correct knowledge of AIDS and application in the prevention of acquisition and transmission of STD.

A community-based cohort of 595 prostitutes from Nairobi was enrolled to study the epidemiology of sexually transmitted diseases (STDs) during January-August 1985. Subgroups were followed at interval of 2 weeks to 1 month during April 1985-March 1987. Reassessments were made during September-December 1985 March-August 1986; and October 1986-June 1987. Of the 595 women 196 were initially HIV-1 antibody-negative. Of these 196 women all who seroconverted to HIV-1 (n = 83) and all who remained HIV-1-seronegative during at least 12 months of follow-up (n = 41) were included in this report. Serology for HIV-1 was done using an enzyme immunoassay (HTLV-III ELISA). Positive specimens were confirmed by HIV-1 Western blot (HTLV-III Western blot). Seroconversion to HIV-1 occurred in 83 women (67%) by the end of June 1987. Annual HIV-1 incidence was 47%. Of 85 women who never used oral contraceptives (OCs) 51 (60%) seroconverted compared with 16 (76%) of 21 who either stopped or started using OCs during the observation period and 16 (89%) of 18 who used OCs throughout the study period (p < 0.05). OC use was associated with HIV-1 infection. Of 39 reporting any OC use 32 seroconverted (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.1-8.6; P m< 0.03). Genital ulcers (mean annual episodes 1.32 +or- 0.55 in seroconverting women vs. 0.48 +or- 0.21 in seronegative women (p < .02) were associated with increased risk of HIV-1 infection. Condom use reduced the risk of HIV-1 infection (OR 0.11; CI 0.05-0.27; p < .0001). Stepwise logistic regression analysis confirmed independent associations between HIV-1 infection and OC use condom use genital ulcers and C trachomatis. The presence of other STDs and genital ulcer disease linked to HIV-1 epidemiology may explain the heterosexual HIV-1 epidemic in Africa. If genital ulcers alter susceptibility to HIV-1 by producing mucosal disruption it seems plausible that other STDs that cause such disruption such as C trachomatis infection also facilitate HIV-1 transmission. This would call for the inclusion of STD control in AIDS control programs.

The majority of patients with congenital clotting disorders who use clotting factor concentrate exhibit lymphocyte subpopulation abnormalities. A subset of these patients develop lymph node enlargement (LNE), part of the spectrum of clinical disease associated with the acquired immune deficiency syndrome (AIDS). It is therefore important to determine if these patients with LNE exhibit specific immune alterations suggestive of early infection with the AIDS agent. We used one- and two-color immunofluorescence to distinguish the lymphocyte subpopulation alterations associated with concentrate use from those associated with LNE. Patients who use concentrate had elevated levels of Leu-2+ (T suppressor phenotype) cells and Leu-7+ (phenotype of some natural killer) cells. These increased levels were largely caused by a dramatic (2.6-fold) increase in the number of lymphocytes co-expressing Leu-2 and Leu-7 (2+7+). A dose-response effect between amount of concentrate infused during the preceding year and level of 2+7+ cells was observed. Concentrate recipients, as a group, also showed increased levels of T cells expressing Dr antigen (T+Dr+ phenotype, characteristic of activated or immature T cells) and cells expressing the T10 antigen (phenotype of some null cells and activated/immature T cells). Patients with LNE showed a further increase in T10+ cells as well as a distinctive decrease in Leu-3+ (T helper phenotype) lymphocytes. All LNE patients exhibited either low Leu-3+ levels, high T10+ levels, or both. Thus, concentrate use was associated with increased levels of Leu-2+ (particularly 2+7+) cells and T+Dr+ cells, whereas LNE was associated with decreased levels of Leu-3+ cells and high levels of T10+ cells.

A malformation syndrome has been proposed in infants with acquired immunodeficiency syndrome or acquired immunodeficiency syndrome-related complex secondary to congenital infection with human immunodeficiency virus (HIV) in the United States and Europe. To determine whether embryopathy is detectable in HIV-exposed African infants, 85 infants of HIV-seropositive mothers and 98 infants of HIV-seronegative mothers in Nairobi, Kenya, were examined for minor and major anomalous features shortly after birth. No mother used intravenous drugs. With the exception of growth failure no anomalous feature was associated with in utero HIV exposure. No increase in the number of anomalous features per infant was correlated with HIV, nor did any infant have the reported malformation syndrome. Thus in this population of African infants examination for anomalous features during the neonatal period failed to identify those infants with fetal exposure to HIV.

The acquired immunodeficiency syndrome (AIDS) is epidemic in Central Africa. To determine the prevalence of AIDS virus infection in East Africa, we studied 90 female prostitutes, 40 men treated at a clinic for sexually transmitted diseases, and 42 medical personnel in Nairobi, Kenya. Antibody to human T-cell lymphotropic virus Type III (HTLV-III) was detected in the serum of 66 percent of prostitutes of low socioeconomic status, 31 percent of prostitutes of higher socioeconomic status, 8 percent of the clinic patients, and 2 percent of the medical personnel. The presence of the antibody was associated with both immunologic and clinical abnormalities. The mean T-cell helper/suppressor ratio was 0.92 in seropositive prostitutes and 1.82 in seronegative prostitutes (P less than 0.0001). Generalized lymphadenopathy was present in 54 percent of seropositive prostitutes and 10 percent of seronegative prostitutes (P less than 0.0001). No constitutional symptoms, opportunistic infections, or cases of Kaposi's sarcoma were present. Our results indicate that the epidemic of AIDS virus infection has, unfortunately, spread extensively among urban prostitutes in Nairobi, Kenya. Sexual exposure to men from Central Africa was significantly associated with HTLV-III antibody among prostitutes, suggesting transcontinental spread of the epidemic.

Hemophiliacs who are exposed to pooled clotting factor concentrate constitute one group at increased risk for development of acquired immune deficiency syndrome. To determine the prevalence of cellular immune aberrations in asymptomatic hemophiliacs, we studied a group of 65 adult hemophiliacs for T-cell subset abnormalities. Sixty-five percent of concentrate recipients had an abnormal T-helper to T-suppressor cell ratio, 40% had a depressed absolute T-helper cell level, and 29% had an elevated absolute T-suppressor cell count. To determine whether horizontal transmission of T-cell subset abnormalities from hemophiliacs to their female sexual partners occurred, we studied 41 spouses. We found no correlation between paired husband and wife values for T-cell ratio or any other immune parameter studied. There were no significant differences found between wives of hemophiliacs with reversed T-cell ratios and wives of hemophiliacs with T-cell ratios of 1.0 or greater, with respect to immunologic tests. We conclude that there is no evidence to date for heterosexual or household-contact transmission of T-cell subset abnormalities from hemophiliacs to their spouses in our study population.