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AFRICA HEALTH. 1992 Jul; 14(5):10-1.An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
Lancet. 1989 Feb 18; 1(8634):396.The World Health Organization (WHO) issued a consensus statement about AIDS and sexually transmitted diseases (STD) and partner notification for patients with HIV infection. Evidence that genital ulcer disease (GUD) is a risk factor and facilitator for HIV-1 infection in heterosexual people is strong, especially in developing countries. A few studies have shown an association of antibodies to herpes simplex virus type 2 (HSV-2) and Treponema pallidum (the chief cause of genital and anorectal ulcers in developing countries). A consistent relation between HIV-1 and HSV-2 and T. pallidum has been demonstrated in seroepidemiological studies. Data assessing the link between other STD pathogens and HIV-1 transmission are insufficient, but it is plausible that all STD pathogens that cause genital ulcers or inflammation are risk factors for increased susceptibility to HIV-1 infection. Investigating this possibility should be a research priority, as genital ulcer diseases intervention may help to prevent sexual transmission of HIV-1 infection. Partner notification programs, as part of a comprehensive AIDS prevention and control program, should be carefully designed. Because the notification procedure can cause individual and social harm and detract from other AIDS prevention and control activities, a careful assessment of medical, legal, logistic, social, and ethical issues needs to be made. Other variables, such as cost, local environment, and epidemiology need to be taken into account. Issues of patient referral, target populations, training of notification personnel, patient consent, diagnostic accuracy, and the logistics of notification need to be addressed. WHO suggests that the following criteria be monitored when assessing efficiency of partner notification activities: number of index persons; number of partners identified; number of partners notified and their seroprevalence; cost; satisfaction; compliance and acceptability; counseling and support; staff training; confidentiality; and adequacy of follow-up.