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Miller, R F; Loveday, C; Holton, J; Sharvell, Y; Patel, G; Brink, N S
doi: 10.1136/sti.72.1.9pmid: 8655183
OBJECTIVES: To evaluate the contribution of community-based respiratory virus infections to lower respiratory tract disease in HIV-1 infected individuals. DESIGN: Prospective clinical cohort study. SETTING: Specialist in-patient unit for HIV and AIDS, University College London Hospitals, London. SUBJECTS: 44 consecutive HIV-1 antibody positive patients who underwent 47 diagnostic bronchoscopies for evaluation of the symptoms and signs of lower respiratory tract disease. TIME: Winter months of 1994/95. MAIN OUTCOME MEASURES: Detection, in bronchoscopic alveolar lavage fluid, of infection with influenza A and B, respiratory syncytial virus (RSV), parainfluenza 1, 2 and 3 (by immunofluorescence and cell culture) and adenovirus and enteroviruses (by cell culture). RESULTS: No evidence of influenza, RSV, parainfluenza, adenovirus, or enterovirus infection was detected. CONCLUSIONS: Despite a marked increase in RSV and influenza B infection in the general population over the winter of 1994-95, respiratory virus infections were not detected in this cohort of HIV infected patients. As the organisms causing lower respiratory tract disease were related to immunosuppression, this study questions the value of routine identification of community-based respiratory viruses in this patient group.
Low, N; Paine, K; Clark, R; Mahalingam, M; Pozniak, A L
doi: 10.1136/sti.72.1.12pmid: 8655159
OBJECTIVES: To describe the rate of progression to AIDS and survival following AIDS diagnosis in HIV-infected Africans living in London. To identify factors influencing progression and outcome of disease. DESIGN: Retrospectively constructed prevalent cohort. SETTING: Outpatient clinic population, London. SUBJECTS: HIV-infected individuals of African origin presenting between January 1986 and October 1994. MAIN OUTCOME MEASURES: AIDS indicator illness; cumulative survival probabilities to AIDS diagnosis and from AIDS diagnosis to death; rate of progression to AIDS. RESULTS: Ninety six patients (57 women) provided 166 person years of follow up. Median CD4 lymphocyte count at presentation was 205 (90% range 20-577) x 10(6)/l. Kaplan-Meier estimates of the proportion (95% confidence interval) of patients developing AIDS from the time of enrollment were 18 (9 to 27)% at 12 months and 44 (30 to 58)% at 36 months. Only CD4 count at HIV diagnosis was independently associated with a faster rate of progression to AIDS (adjusted relative hazard 9.18%, 95% confidence interval 2.84 to 29.67, p < 0.001). The proportion (95% confidence interval) surviving following AIDS diagnosis was estimated to be 73 (55 to 91)% at 12 months and 25 (0 to 52)% at 36 months. CONCLUSIONS: HIV-infected people of sub-Saharan African origin living in London present with advanced disease. When compared with published studies, their survival experience is comparable to that observed in HIV-infected individuals born in developed countries.
Bowden, F J; Mein, J; Plunkett, C; Bastian, I
doi: 10.1136/sti.72.1.17pmid: 8655160
OBJECTIVES: To determine the effectiveness of azithromycin, an azalide antibiotic with long tissue half-life, in a pilot study of patients with genital donovanosis in the Northern Territory, Australia. DESIGN: Patients with histologically confirmed donovanosis were randomised to receive one of two open-label azithromycin dosage regimens: Regimen A--1.0 g once weekly for 4 weeks; or Regimen B--500 mg daily for 7 days. Patients were assessed at 6 weeks and classified as either "cured", "improved" or "failed". RESULTS: Seven patients received regimen A and 4 received regimen B. Six weeks after commencing treatment the genital ulcers of four patients receiving regimen A and one patient receiving regimen B had healed; the lesions of the other six patients (3 in each regimen) were "improved". No patient failed to respond and no significant adverse reaction was recognised. The eleven patients were reviewed after completing the six-week trial; all lesions had re-epithelialised without further antibiotic treatment, no relapses had occurred, the longest follow-up period being seven months. A further 17 patients with donovanosis who were unable to meet the entry criteria were also treated successfully with azithromycin during the study period. CONCLUSIONS: This is the first time that azithromycin has been shown to have clinical activity against donovanosis. Poor compliance with prolonged courses of antibiotics is one of the major barriers to control of the disease. Intermittent or short-course therapy, made possible by the long tissue half-life of the drug, could facilitate control of donovanosis in endemic populations if the high cost of medication can be addressed.
Herrmann, B; Espinoza, F; Villegas, R R; Smith, G D; Ramos, A; Egger, M
doi: 10.1136/sti.72.1.20pmid: 8655162
OBJECTIVE: To validate the performance of a direct fluorescence antibody (DFA) test and to determine the prevalence, risk factors and clinical manifestations of cervical chlamydia infection in different groups of women in Nicaragua. STUDY POPULATION: 926 women, 863 routine clinic attenders (mean age 27 years) and 63 sex workers (mean age 25 years) attending health centres in León, Corinto, Matagalpa and Bluefields. METHODS: Cervical specimens were examined using the Syva MicroTrak test system with a cut-off of 10 or more elementary bodies (EBs). The DFA results were validated by a one-step polymerase chain reaction (PCR) assay. Discordant results were further examined in nested PCR assays directed at two different target genes. An interviewer-administered questionnaire and a standard gynaecological examination were completed. RESULTS: Sensitivity of DFA was 80.1%, specificity 98.3%, and positive and negative predictive values 62.5% and 99.3%, respectively. Values were lower in locations where samples thawed because of electricity breaks and higher among sex workers. The majority of discordant results was confirmed as positive in nested PCR assays. Prevalence of cervical chlamydia infection based on positivity in DFA and/or PCR ranged from 2% among routine clinic attenders aged 35 years or older, to 8% among adolescent clinic attenders, and to 14% among sex workers. Among routine clinic attenders, young age (odds ratio [OR] 3.6, 95% confidence intervals [95% CI] 1.4-8.9 for women aged 15-19 years as compared with 1 in women 25 years of age or older) and use of oral contraceptives (OR 4.0, 95% CI 1.7-9.6) were the only statistically significant risk factors identified in multivariate logistic regression analysis. Presence of mucopurulent cervical discharge (OR 5.9, 95% CI 3.0-11.5) and presence of ectropion (OR 2.6, 95% CI 1.1-6.5) were the clinical signs independently associated with infection. CONCLUSIONS: Our results indicate that the DFA test was sensitive and specific while the performance of the PCR assay depends on adequate storage of samples. Genital C trachomatis infection is a common health problem among women in Nicaragua. The wide implementation of syndromic STD management algorithms together with health education programmes aimed at young people is the most promising approach to control STD in Nicaragua.
Maini, M K; Gilson, R J; Chavda, N; Gill, S; Fakoya, A; Ross, E J; Phillips, A N; Weller, I V
doi: 10.1136/sti.72.1.27pmid: 8655163
BACKGROUND: CD4 lymphocyte counts are used to monitor immune status in HIV disease. An understanding of the variability of CD4 counts which occurs in the absence of HIV infection is essential to their interpretation. The sources and degree of such variability have not been extensively studied. OBJECTIVES: To establish reference ranges for CD4 counts in HIV-seronegative women and heterosexual men attending a genitourinary medicine (GUM) clinic, and to identify possible differences according to gender and cigarette smoking and, in women, any effect of the menstrual cycle, oral contraceptive use and cigarette smoking. DESIGN: Female and heterosexual male patients attending a GUM clinic and requesting an HIV-antibody test were recruited prospectively. Results from an earlier study of CD4 counts in homosexual men were available for comparison. METHODS: Lymphocyte subpopulation analysis on whole blood by flow cytometry. RESULTS: The absolute CD4 count and percentage of CD4 cells (CD4%) were significantly higher in women (n = 195) than heterosexual men (n = 91) [difference between the means 111 x 106/1 (95% CI 41, 180) and 3.1% (1.30, 4.88)]. The absolute CD4 count and CD4% were also significantly higher in smokers (n = 143) than non-smokers (n = 140) [difference 143 (79, 207) and 2.1% (0.43, 3.81)]. Reference ranges for absolute CD4 counts (geometric mean +/- 2SD) were calculated on log transformed data as follows; female smokers 490-1610, female non-smokers 430-1350, heterosexual male smokers 380-1600, heterosexual male non-smokers 330-1280. Among other variables examined, combined oral contraceptive pill use was associated with a trend towards a lower absolute CD4 count. Changes were seen in CD4% with the menstrual cycle. CD4 counts and CD4% did not differ significantly between heterosexual men and homosexual men (n = 45). CONCLUSION: There is a significant gender and smoking effect on CD4 counts. The effects of oral contraceptive use and the menstrual cycle warrant further investigation.
Andersson-Ellström, A; Forssman, L; Milsom, I
doi: 10.1136/sti.72.1.32pmid: 8655164
PURPOSE: To assess longitudinally the relationship between knowledge about sexually transmitted diseases (STDs) and sexual behaviour, contraceptive use, STD protection and social class in a group of Swedish teenage girls. METHODS: Girls starting their upper secondary school education were invited to attend a teenage clinic during a period of 2 years (5 visits). Questions were asked about family situation, sexual activity, contraceptives, STD protection and knowledge about STD. Gynaecological examinations were performed on entry and completion, and when necessary during the observation period. RESULTS: Eighty-eight girls completed all visits during the observation period. At 16 years of age there were no significant differences in knowledge about various STD and STD protection between girls from different social classes or with respect to coital experience, age of coitarche and the subsequent number of sexual partners at 18 years of age. At 18 years of age there was a better knowledge about STDs and the need for STD protection (p < 0.01) among girls with coital experience compared with those who had no coital experience. Girls reporting many lifetime partners were best informed, but in spite of solid knowledge they did not protect themselves from infection. Even though 34% of the girls with coital experience were found to harbour a STD during the course of this study, almost all girls denied the possibility of having acquired or transmitted an infection. CONCLUSIONS: Although girls were well-informed about sexually transmitted diseases and knew how to avoid infections this knowledge had little influence on behaviour.
Cribier, B; Schmitt, M P; Le Coz, C; Grosshans, E
doi: 10.1136/sti.72.1.37pmid: 8655165
OBJECTIVE: To evaluate the sexual behaviour changes in patients attending HIV testing during the period July 1988 to June 1994. DESIGN: In a prospective study, 6824 face-to-face interviews were carried out before the HIV test was performed. The frequency of condom use and the number of sexual partners during the 6 previous months were recorded annually from July to June. The data were analysed according to gender, age class and sexual orientation. SETTING: Strasbourg, Bas-Rhin, France. SUBJECTS: Patients attending the HIV testing centre of Strasbourg. RESULTS: There was a striking increase in the number of attenders of this centre from 358 patients in 1988/89 to 2421 in 1993/94. We observed a significant decrease of homosexuals having more than five partners (p < 0.05) whereas multipartner sex remained unchanged in heterosexuals. There was no change in the proportion of patients having only one partner, except a slight raise in patients under 20 years. All groups showed a very significant increase in condom use, which was especially marked in young heterosexuals aged under 30 years. Nevertheless, condom use remained higher in homosexuals than in heterosexuals in 1993/94. In addition, there was a striking fall of past sexually transmitted disease in heterosexual patients under 20 years during the study period, and a fall in the HIV positivity rate from 1.96% to 0.42%. CONCLUSIONS: A major increase was noted in condom use in all groups and a reduction of multipartner sex in some patients. These data are encouraging in the younger patients, but prevention efforts should also be concentrated on middle aged patients who did not show major sexual changes, although having important risk factors for HIV infection.
Mendelsohn, R; Astle, L; Mann, M; Shahmanesh, M
doi: 10.1136/sti.72.1.43pmid: 8655166
OBJECTIVE: To investigate frequency of sexual encounters with new partners abroad in patients attending a genitourinary clinic (GUM). METHODS: In a case series 464 attenders at a genitourinary medicine clinic completed an anonymous self-administered questionnaire, if they had been abroad recently, enquiring about sexual behaviour abroad. RESULTS: 28.4% of subjects admitted to sex with a new partner abroad with only 41.7 per cent consistently using condoms. There were no significant differences in condom use for gender, ethnicity or type of visit and relationship. Twenty-nine per cent of those admitting to sex abroad had more than one partner. The risk of multiple partners was not associated with gender, ethnicity, type of visit (holiday or business) or type of relationship (heterosexual or homosexual). The first partner abroad for 63% of men and 62.5% of women was of a nationality other than that of United Kingdom residents. Non-Caucasians and homosexuals were significantly more likely to have first partners abroad from outside the UK than Caucasians and heterosexuals respectively. CONCLUSION: The occurrence of casual sex abroad in GUM attenders suggests that further research is needed to establish targetable risk factors for this type of behaviour amendable to change through health promotion.
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