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  1. 1
    Peer Reviewed

    Evidence behind the WHO guidelines: hospital care for children: what is the aetiology of pneumonia in HIV-infected children in developing countries?

    Calder D; Qazi S

    Journal of Tropical Pediatrics. 2009 Aug; 55(4):219-24.

    This clinical review discusses the most common cause of pneumonia in HIV-infected children--bacterial pathogens and includes recommendations for the management of pneumonia in HIV-infected children from World Health Organization (WHO).
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  2. 2
    Peer Reviewed

    The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia.

    Lynen L; Thai S; De Munter P; Leang B; Sokkab A

    Journal of Acquired Immune Deficiency Syndromes. 2006 Jul; 42(3):322-324.

    In a retrospective study of 648 persons with HIV infection in Cambodia, we determined the sensitivity, specificity, and accuracy of the 2003 World Health Organization (WHO) criteria to start antiretroviral treatment based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, we used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% to identify patients who need highly active antiretroviral therapy (HAART). In our clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone was a good predictor of those needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/KL, and 73% had weight loss of more than 10% as a stage-defining condition. Our data suggest that, in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment. (author's)
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  3. 3

    Hepatitis B in St Petersburg, Russia (1994-1999): incidence, prevalence and force of infection.

    Beutels P; Shkedy Z; Mukomolov S; Aerts M; Shargorodskaya E

    Journal of Viral Hepatitis. 2003 Mar; 10(2):141-149.

    Hepatitis B (HB) is thought to be an expanding health problem in Russia. The incidence of infection was estimated from mandatorily reported HB cases in St Petersburg. The two-sided t-test for independent samples and the LOESS (locally-weighted regression) smoother were used to compare the age at infection for symptomatic, asymptomatic and chronic infections, by gender. The force of infection was estimated from seroprevalence data (907 sera taken in 1999) using a newly developed nonparametric method based on local polynomials, as well as an earlier method based on isotonic regression and kernel smoothers. With the local polynomial method, pointwise confidence intervals (95%) were constructed by bootstrapping. On average, men contracted HB infection at a significantly younger age than women (in 1999, 21.8 vs 22.7 years, respectively). The overall male to female ratio was 1.92. In 1999 the overall incidence almost doubled compared with the preceding years and tripled among the age groups with highest incidence (15–29-year olds: 85% of cases in 1999). The incidence increase was associated with a lower average age at infection (24.1 years in 1994 vs 22.1 years in 1999). The age and gender-specific force of infection estimates generally confirmed the incidence estimates and emphasized the usefulness of local polynomials to do this. Hence HB transmission in St Petersburg occurs mainly in young adults. The dramatic increase of infections in 1999 was probably due to injecting drug use. Without intervention, HB virus is expected to continue to spread rapidly with a greater proportion of female infections caused by sexual transmission. These trends may also provide an indication for HIV transmission. (author's)
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  4. 4
    Peer Reviewed

    Second meeting of the WHO Collaborating Centres on AIDS: memorandum from a WHO meeting.

    World Health Organization [WHO]. Collaborating Centres on AIDS

    Bulletin of the World Health Organization. 1986; 64(1):37-46.

    The 2nd meeting of the World Health Organization (WHO) Collaborating Centers on Acquired Immunodeficiency Syndrome (AIDS) was held in Geneva on December 16-18, 1985. Participants reviewed the progress made since the 1st meeting in September 1985 and delineated a program for the further development of collaborative activities between WHO, its network of Collaborating Centers, and Member States. Specific recommendations were made in the following areas: information, education, and prevention; reference reagents and testing for antibodies against lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III); epidemiologic assessment; and research on vaccines and antiviral agents. It is noted that technical cooperation and epidemiologic assessment should be individualized, based on differences in the prevalence of LAV/HTLV-III infection in a country and the different epidemiologic, clinical, and laboratory capacities of countries. Consultation between WHO and Member States should lead to the establishment of surveillance and laboratory capabilities for assessing the prevalence of AIDS and LAV/HTLV-III infection on a continuing basis, identifying the risk factors for transmission, and assessing prevention activities. Each WHO region should have at least 1 collaborating center with the following tasks: assist in planning and conducting initial studies, provide technical expertise for the development of national laboratory diagnosis systems, assist in laboratory training, perform confirmatory serologic tests, conduct quality control testing, provide proficiency testing, provide reference materials and reagents, and assist in disseminating technical information. Research on the development of a simplified, reliable method for LAV/HTLV-III isolation and quantitation should be encouraged. Finally, appropriate testing systems in animals are urgently needed both for vaccine development and therapeutic intervention.
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  5. 5
    Peer Reviewed

    Evaluation of two staging systems for HIV infection for use in developing countries.

    Vandenbruaene M; Colebunders R; Goeman J; Alary M; Farber CM; Kestens L; Van Ham G; Van den Ende J; Van Gompel A; Van den Enden E

    AIDS. 1993 Dec; 7(12):1613-5.

    In 1990, Belgium, physicians enrolled 415 consecutive patients attending HIV reference centers in Antwerp, Brussels, and Ghent in a cross-sectional study designed to evaluate the clinical axis of the WHO staging system with and without the lymphocyte stratification proposed by Montaner el al. (that is, modified WHO staging system) (>1500, 1500- 1000, and <1000 cells x 1 million/l). They filled in a standardized questionnaire with all criteria of the WHO staging system. Laboratory personnel used standard hematology and flow cytometry techniques to determine absolute and CD4 lymphocyte counts. 80% of the patients were Caucasians. 46% of all patients were homosexual and 42% were heterosexual; 79.2% were men. Median CD4 lymphocyte counts fell in both staging systems as the stage of HIV infection increased. There were significant differences in median CD4 counts between stages of each staging system (p < .001). The modified WHO staging system's stage I was more sensitive at identifying patients with CD4 lymphocyte counts of more than 500 cells x 1 million/l than the WHO clinical stage 1 (83% sensitivity vs. 48% sensitivity). The positive predictive value of WHO clinical stage 4 and of the modified WHO staging system's stage IV for identifying people with CD4 lymphocyte counts of less than 200 cells x 1 million/l was quite high (79% and 80%, respectively). The researchers suggested that clinicians use stages 4 and IV as end-points is clinical trials in developing countries. Clinicians completing the questionnaire knew the patients' earlier CD4 lymphocyte count, which may have introduced a bias in the study. For example, they may have more thoroughly examined patients with low CD4 lymphocyte counts than those with normal counts. Nevertheless, the study's results indicated that either one of these systems may be a good alternative in developing countries to the technical equipment-dependent CD4 lymphocyte count-based HIV staging system used in developed countries. Cohort studies in developing countries would evaluate their prognostic value.
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  6. 6

    Clinical manifestation of HIV infection in Northern Zaire [letter]

    Strecker W; Gurtler L; Binibangili M; Strecker K

    AIDS. 1993 Apr; 7(4):597-8.

    Commentary is directed to the effectiveness in low HIV seroprevalence countries of the use of the 1985 Centers for Disease Control/World Health Organization (CDC/WHO) clinical case definitions for AIDS. A study of HIV-1 and HIV-2 seroprevalence was conducted at the Regional Hospital of Gbadolite, Northern Zaire, in order to examine the relationship between clinical symptoms and the presence of HIV infection. The results showed that in a sample of 667 healthy subjects, who were blood donors and surgical patients without HIV symptoms, 8.2% were HIV-1 seropositive. 30 men (5.8%) and 25 women (17.1%) out of the 521 had HIV-1 antibodies, and no one had HIV-2 antibodies. A sample of 465 patients, who had at least one minor or major clinical symptom of AIDS corresponding to the CDC/WHO clinical case definition, showed 54 of the 200 men (27%) and 129 of the 265 women (48.7%) as seropositive. The conclusion was that specificity was poor for diagnosis of AIDS based on clinical case definitions. In another sample of 143 patients, different from the CDC/WHO clinical case definitions were: pyogenic abscess, tubo-ovarian abscess, epididymitis/orchitis, condylomata acuminata, piles, vaginal ulcerations, recurrent abortions, and amenorrhea/infertility. Further investigations of clinical symptoms are still needed, particularly where expensive testing for HIV infections is curbed by shortages in funding. Technical barriers also prevent reliable and practical HIV testing. It is recognized that the CDC/WHO definition was valuable in detecting cases in Uganda. Other field studies among African populations with HIV seroprevalence of 34-42% showed that the CDC/WHO definition had a specificity of 85-90%, a sensitivity of 55-59%, and a positive predictive value of 73%.
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  7. 7

    AIDS without HIV: fire without smoke [editorial]

    Bird AG

    BMJ. British Medical Journal. 1992 Aug 8; 305(6849):325-6.

    The press widely publicized investigative findings at the international AIDS conference in Amsterdam, the Netherlands about patients with signs or symptoms consistent with AIDS or AIDS-related complex but who did not have HIV-1 or HIV-2 antibodies or the viruses themselves. Yet the formal scientific sessions ignored this topic and the conference summaries only casually mentioned it. Tests used to try to detect HIV were antibody testing, virus isolation, or molecular detection techniques. The press suggested several emotive questions not based on clinical data such as the safety of national blood supplies. 4 of the 5 patients in New York City had HIV risk factors. The only clinical indications of immunodeficiency in 1 patient was Mycobacterium tuberculosis infection and 2 somewhat low CD4 counts which may have actually been due to tuberculosis. Laboratory personnel have not yet reconfirmed reverse transcriptase activity of lymphocytes from 2 patients. So far these cases do not exhibit epidemiological criteria for a new transmissible agent. There has been no case clustering or a pattern of sexual or vertical association of cases. These cases may only be more detections of cases of rare spontaneous primary or secondary immunodeficiency disease. If epidemiological support does suggest a transmissible agent, laboratory personnel may find it difficult to isolate and identify agent. The US Centers for Disease Control and WHO wants to coordinate reporting and classification of cases so epidemiologists can quickly verify or reject laboratory findings based on a larger series of cases. Only with full evaluation of ongoing research and development of sensitive and specific detection systems for new pathogens can the scientific community address questions concerning the safety of blood supplies. This reaction of the press indicates a need for the peer review system to continue to establish the soundness of research before its release to the press to avoid undue concern.
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  8. 8
    Peer Reviewed

    International doubts about a Kenyan cure.

    SCIENCE. 1990 Oct 12; 250:200.

    Researchers in Kenya claim that small doses (100 unites) of oral alpha interferon depressed symptoms in AIDS patients and, in 10% of patients, all signs of HIV infection disappeared. President apap Moi promotes these findings. AIDS patients from other African countries and the US have since gone to Kenya seeking treatment. Yet the Western biomedical establishment is not showing much enthusiasm, not even the man who introduced the notion of using low dose oral alpha interferon to treat AIDS to the principal investigator. WHO has supported a sequence of rapid test of alpha interferon in other African countries. Experts at WHO headquarters believe alpha interferon is unproven as an AIDS drug and requires more study. Both the Kenyan study and the WHO studies were uncontrolled studies. Further the patients in the studies received different formulations of alpha interferon. WHO now calls for properly controlled formulations of alpha interferon. WHO now calls for properly controlled clinical trials. In New York City and Amarillo, Texas, 2 such small trials are indeed occurring. So far, however, preliminary data do not indicate changes in T cell counts. Thus alpha interferon has not caused improvement in immune status. US National Institute of Allergy and Infectious Diseases researchers have injected large doses of recombinant forms of alpha interferon in asymptomatic HIV infected subjects and viral production slowed down. In fact, the risk of developing opportunistic infections decreased. A phase III clinical trial of injectable alpha interferon alone and with the nucleoside analogs AZT and ddI is under way. Further millions of units of injectable alpha interferon is now used to treat people with Kaposi's sarcoma and genital warts. Kenyan officials are so confident of alpha interferon's ability to treat AIDS that it plans on mass producing it and patent the formulation. Yet a US veterinarian in Texas already has several patents on it.
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  9. 9

    The Africa syndrome. India confronts the spectre of a massive epidemic.

    McDonald H

    FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.

    As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
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  10. 10

    Report of a WHO Consultation on the Prevention of Human Immunodeficiency Virus and Hepatitis B Virus Transmission in the Health Care Setting, Geneva, 11-12 April 1991.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1991. [3], 8 p. (WHO/GPA/DIR/91.5)

    The transmission of both Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in health care settings causes concern among patients, health care workers, and national policymakers. This document reports recommendations from a consultative meeting on the issue organized by the World Health Organization Global Program on AIDS. The meeting was held at the request of member states to review risks of transmission of HBV and HIV in the health care setting, and to provide guidance on policies and strategies to minimize such risks. In order of declining incidence and likelihood, HBV and HIV may be transmitted from patient to patient, patient to worker, and worker to patient. The risk of infection depends on the prevalence of infected individuals in the population, the frequency of exposure to contaminated medical instruments, relative viral infectivity, and the concentration of virus in the blood. The risk of acquiring HBV from a needlestick exposure to blood of an infected patient is estimated at 7-30%, while less than 0.5% of health care workers exposed in similar fashion to HIV+ blood have become infected with HIV. General recommendations and specific measures for WHO and national authorities to adopt in the prevention of these infections are listed. Central to prevention is the adoption by health care workers of universal precautions which assume that all blood and certain bodily fluids are infectious. HBV vaccines for both health care workers and as a routine infant immunogen are recommended where appropriate. Routine and/or mandatory blood testing of workers or patients is not recommended, and is considered potentially counterproductive to AIDS control.
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  11. 11

    Towards better diagnosis.

    Payne D

    WORLD HEALTH. 1991 Sep-Oct; 12.

    A researcher with WHO's Tropical Disease Research Programme reviews techniques used to diagnose malaria. Present techniques have not improved much since a French physician 1st used a microscope in 1880 to examine blood from a sick soldier and then noticed the parasites of Plasmodium falciparum. Yet optical quality has improved and special stains can now be used to color the parasites making them more recognizable. In fact, at a magnification of 600-700 times, a scientist can identify all 4 plasmodia, the blood forms of the plasmodia, and count the plasmodia. Blood samples and a microscope allow physicians to monitor the ill person's progress after they began treatment. Yet a microscope and the needed laboratory skills and other resources are not always present in health center in a village in countries where malaria is endemic. It is here where simple and effective techniques are needed the most. 1 approach is to detect antibodies to the plasmodia, but this takes much time. In addition, antibodies are only present after an individual has been infected for a relatively long time. Thus this technique cannot detect malaria early enough to provide proper treatment. Another approach readily identifies antigens. Yet the techniques required are complicated and require a lot of time. Besides antigen techniques are not as reliable as microscopic diagnosis. Researchers are presently experimenting on simple visual methods which are quick, inexpensive, and reliable. Molecules in the plasmodia which are in a small amount of blood will either react or not react with reagents incorporated on a dipstick or card. Thus physicians can detect what plasmodia are present and estimate parasite load. Another test can inform the physicians what antimalarial to prescribe and how much and resistance of the plasmodia to the antimalarial.
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  12. 12

    The breastmilk controversy.

    Panos Institute

    WORLDAIDS. 1992 Jan; (19):11.

    In 1991, researchers followed 212 mothers and infants who tested HIV-1 negative at delivery in Rwanda. Later 8 infants tested HIV positive. Both the infants and mothers became infected simultaneously. They ruled out other routes of infection and concluded that the colostrum and breast milk were possibly the route of infection for 4 infants and positively the route for 4 infants. They postulated that when one 1st becomes infected with HIV, one may have high levels of HIV in the blood and thus be more infectious in the time period between 1st contracting HIV and development of HIV antibodies. All the mothers were vulnerable to sexual exploitation because they were either unmarried or widowed or had absent husbands and unstable sexual partnerships. Thus the risk factor of economic and social instability enhanced their vulnerability to exposure to HIV. The researchers suggested that heal professionals should counsel HIV negative mothers who are at high risk about the possibility of transmitting HIV via breast milk if they happen to seroconvert. In some developing countries like Rwanda, no alternatives to breast feeding exist so the researchers advocated intervention studies to assess the efficacy and feasibility of alternative nutritional practices, such as wet nursing, for mothers at high risk of acquiring HIV after delivery. They did not conclude that already HIV infected mothers should not breast feed since research had not yet proved that infants acquire HIV from breast milk of infected mothers. In fact, other research showed that HIV positive infants who are breast fed live longer than bottle fed HIV infants. After publication of this study, WHO continued its commitment to promote, protect, and support breast feeding no matter what the HIV prevalence of a country is.
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  13. 13

    The epidemiological evolution of HIV infection.

    Greco D


    Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
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  14. 14

    What use is a clinical case definition for AIDS in Africa?

    Gilks CF

    BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1189-90.

    The article proposes that the clinical case definition for Acquired Immunodeficiency Syndrome in Africa is an unworkable concept, with the wrong definition, incorrect validation, improper use, and consequently is a poor surveillance tool. The definition was proposed by the World Health Organization in 1986 to satisfy the use in countries with limited diagnostic resources, and resources for serological testing. Critical review until now of this procedure was lacking. Currently serological testing is available and of high quality. It does not seem justifiable to continue using a provisional surveillance definition. Abandoning this classification procedure may also lead to the focus on problems other than opportunistic infections and AIDs. Clinical surveillance is important, but as well morbidity and mortality need monitoring. It is argued that the definition is an unworkable concept because patients with underlying immunosuppression disorders such as AIDs can not be easily distinguished from chronic disease patients; i.e., pulmonary tuberculosis, renal failure, uncontrolled diabetes, or diarrhea with weight loss. Clinical accuracy is insufficient. It is the wrong definition because pulmonary tuberculosis with a persistent cough cannot be distinguished for those HIV positive and those not. There is inconsistency in the WHO clinical definition and the Centers for Disease Control definitions of AIDs. The incidence of tuberculosis in countries with unmodified clinical case definitions may contribute to an inflated number of AIDs cases. The wrong standards were used to validate the WHO definition in evaluative studies. The reference sensitivity ranges indicate that the definition is insensitive to identifying seropositive patients. Also, the HIV status of patients does not equate with AIDs. Although designed for surveillance, the clinical case definition is used by doctors for individual patient management. Labeling a patient as having AIDs, when he is HIV negative, leads to negative consequences. Researchers compare African AIDs data with North American data with imprecise and noncomparable definitions. As a surveillance tool in countries with a fragmentary or without a vital registration system, it is an inaccurate tool. Alternatives to obtaining data about the spread and impact of HIV are cluster sampling, hospital surveillance of selected populations, anonymous testing of pregnant women or patients in sexually transmitted disease clinics. In Nairobi, a necropsy survey found that 16% had AIDs but 38% were HIV positive.
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  15. 15

    AIDS in India: constructive chaos?

    Chatterjee A

    HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.

    Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
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  16. 16

    Report of the Global Blood Safety Initiative Meeting, Geneva, 16-17 May 1988.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1988. 15 p. (WHO/GPA/DIR/88.9)

    Following up on a January, 1988, meeting at World Health Organization headquarters, this meeting was held to inform participants about the present status of blood transfusion systems worldwide, study obstacles to developing integrated systems, achieve consensus on the objectives, principles and activities of the Global Blood Safety Initiative and structure of a previously proposed consortium, and to endorse and launch the initiative. Objectives, principles, and consortium activities are presented in the report, followed by discussion of the organization and activities of the consortium secretariat. Evolution of the Global Blood Safety Initiative is also explained in the report, and results largely out of need for safe blood supplies in the face of AIDS. Instead of stressing long-term infrastructure development toward integrated blood transfusion services, priority was placed upon HIV prevention, with care to not link too closely in the public eye AIDS with hopes for strengthened blood transfusion services. Participants were keen to point out that the initiative will not fuel additional bureaucracy, and that patients is paramount in realizing initiative goals. Realistic targets must be set, and steady, gradual improvements should be expected. Where bilateral arrangements are concerned, support to countries should be provided in accordance with the national AIDS plans of each respective country. Linking country needs with available resources, the initiative would be a facilitating, integrating force.
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  17. 17

    Report of the Meeting on Strategies for the Evaluation and Implementation of Laboratory Diagnosis of HIV Infection, Geneva, 31 August - 2 September 1988.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1989. 6 p. (WHO/GPA/BMR/89.2)

    A World Health Organization (WHO) meeting was held to review strategies for WHO activities in the laboratory diagnosis of HIV infection, and to propose feasible, practical ways of implementing recommendations from the Stockholm, 1987, meeting on "criteria for evaluation and standardization of diagnostic tests for detection of HIV antibody." The meeting commended efforts made over the previous 8 months by the WHO global program on AIDS in evaluating new test systems, training laboratory workers, and monitoring test performance. The paper reports recommendations regarding choice of test, training, quality control procedures, and research.
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  18. 18
    Peer Reviewed

    The value of a clinical definition for epidemic KS in predicting HIV seropositivity in Africa.

    Desmond-Hellmann SD; Mbidde EK; Kizito A; Hellmann NS; Ziegler JL

    Journal of Acquired Immune Deficiency Syndromes. 1991; 4(7):647-51.

    Kaposi's sarcoma (KS) in African adults can present in both endemic (non-HIV related) and epidemic (HIV related) forms and in this paper, the authors evaluated the usefulness of a clinical case definition for epidemic KS in predicting HIV seropositivity. A total of 235 patients with KS presenting to the Uganda Cancer Institute from January 1, 1988-March 31, 1990 were evaluated with history and physical examination. Symptomatic patients underwent chest radiography and upper gastrointestinal endoscopy. 174 (80%) underwent HIV ELISA testing with Western blot confirmation. The clinical case definition had a 91% sensitivity and a 95% specificity in predicting HIV seropositivity. Oral KS was the most sensitive specific site of involvement in predicting HIV seropositivity. The clinical case definition is useful in assessing patients to determine prognosis and likelihood of responding to aggressive therapy. (author's)
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  19. 19
    Peer Reviewed

    Clinical features of paediatric AIDS in Uganda.

    Lambert HJ; Friesen H


    A total of 177 children seen at 2 hospitals in Kampala are described who were strongly suspected of having acquired immunodeficiency syndrome (AIDS), either on clinical grounds or because they fulfilled WHO case- definition criteria for diagnosis of pediatric AIDS. Blood was taken from the 177 children and 154 of their mothers and tested for antibody to human immunodeficiency virus (HIV) by an enzyme-linked immunoassay (ELISA). Altogether, 119 (67%) children were seropositive, but only 85 (71%) fulfilled the WHO case-definition criteria, and they were significantly older than the 34 who did not fulfill the criteria. A further 58 children were seronegative but fulfilled the WHO criteria. Of the 119 seropositive children, only 3 had a history of previous blood transfusion, but 103 (98%) of 105 mothers were HIV seropositive: consequently, their children were considered to have been infected in utero or perinatally. 13 (26%) of 49 mothers of seronegative children were seropositive. 80% of HIV-infected children were under 2 years of age at diagnosis and 23% died within 3 months of diagnosis. None of the parents was known to be an intravenous drug user, a prostitute, or bisexual. The difficulty of accurate diagnosis of AIDS presents a major problem in Africa, as the WHO clinical case-definition criteria alone are clearly not adequate. (author's)
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  20. 20

    Evaluation of the WHO clinical case definition for AIDS in Uganda.

    Widy-Wirski R; Berkley S; Downing R; Okware S; Recine U; Mugerwa R; Lwegaba A; Sempala S

    JAMA. 1988 Dec 9; 260(22):3286-9.

    In Africa, as in many developing countries where AIDS has been documented, the specific serologic test for antibody to the human immunodeficiency virus is not feasible, and the case definition of the Centers for Disease Control is impracticable because facilities for diagnosing the opportunistic infections are inadequate and the clinical spectrum of AIDS is different in tropical countries. The World Health Organization developed a clinical case definition at a 1985 AIDS workshop in the Central African Republic. It was tested to determine its generalizability in Zaire, and the present paper is a report on experience using the definition to identify AIDS in Uganda. A clinical case of AIDS is defined by the presence of at least 2 major signs and 1 minor sign. The major signs are fever for more than 1 month, weight loss greater than 10%, and chronic diarrhea for more than 1 month. The minor signs are persistent cough for more than 1 month, pruritic dermatitis, herpes zoster, oropharyngeal candidiasis, ulcerated herpes simplex, and general lymphadenopathy. The presence of disseminated Kaposi's sarcoma or disseminated cryptococcosis is sufficient by itself to diagnose AIDS. The Uganda study included 1328 patients at 15 hospitals. 562 patients (42%) tested positive by enzyme-linked immunosorbent assay, and 776 (58%) tested negative. 424 patients (32%) met the world Health Organization clinical case definition for AIDS. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. However, so many of the patients in this sample had active tuberculosis that it was decided to substitute "persistent cough for more than 1 month without concurrent tuberculosis" as a minor sign in place of "cough for longer than 1 month." With this modification 350 patients met the clinical case definition for AIDS. Sensitivity dropped to 52%, but specificity rose to 92%, and positive predictive value rose to 83%. Moreover, 26% of the seropositive females indicated amenorrhea as a symptom. Addition of amenorrhea to the modified case definition gave it a sensitivity of 56%, a specificity of 93%, and a positive predictive value of 86%. However, this is the 1st report of amenorrhea as a symptom of AIDS, and it may only be a symptom of severe weight loss in women of childbearing age. The findings in the Ugandan experience support the generalizability of the modified World Health Organization clinical case definition of AIDS and its use for surveillance purposes in Africa.
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  21. 21
    Peer Reviewed

    The acquired immunodeficiency syndrome (AIDS): memorandum from a WHO meeting.

    Ancelle R; Assaad F; Bijkerk H; Borgucci PV; Bottiger M; Brunet JB; Byfchenko B; Causse G; Clayton AJ; Curran JW


    An International Conference on Acquired Immunodeficiency Syndrome (AIDS), sponsored by the US Department of Health and Human Services and the World Health Organization (WHO) in April 1985, was attended by 3000 participants from 50 countries. This memorandum summarizes information presented at the conference regarding the natural history and transmission of AIDS, and AIDS virus, laboratory testing, clinical findings, blood transfusions and AIDS, vaccine development, and information and health education. On the basis of this material, the following conclusions and recommendations were formulated. At the international level, action should be taken to: 1) establish a network of collaborating centers with special expertise in the field; 2) coordinate global surveillance of AIDS using a compatible reporting format and the currently accepted case definition; 3) assist in the development of an effective vaccine; and 4) encourage and assist in periodic serologic studies in countries where AIDS has not yet been recognized. At the national level, action should be taken to: 1) inform the public that lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) infection is acquired through homosexual and heterosexual intercourse, needle sharing by intravenous drug abusers, transfusion of contaminated blood and blood products, and transmission from mothers to their babies; 2) ensure that health care workers are informed about AIDS; 3) assess the risk that AIDS poses to each country's population and establish methods of diagnosis, surveillance, and laboratory testing; 4) screen where feasible potential donors of blood and plasma for HTLV-III antibodies; 5) reduce the risk of transmission of HTLV-III in factor VIII and IX concentrates by heat treatment; 6) discourage organ and sperm donations from members of high-risk groups; 7) refer seropositive individuals for medical evaluation and counseling; 8) develop guidelines for the total care of AIDS patients and for handling specimens; and 9) maintain the confidentiality of seropositive and AIDS patients.
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  22. 22

    WHO activities for the prevention and control of acquired immunodeficiency syndrome (AIDS): report by the Director-General.

    World Health Organization [WHO]

    [Unpublished] 1985 Nov 25. 9 p. (EB77/42.)

    This report assesses the current situation with regared to acquired immunodeficiency syndrome (AIDS), describes activities being carried out by the World Health Organization (WHO), and indicates the course of future action to understand and control AIDS, particularly the assurance of safe blood and blood products. The WHO program on AIDS has the following components: 1) the exchange of information and the participation of Member States and WHO collaborating centers on AIDS in data collection; 2) the preparation and distribution of guidelines, manuals, and educational materials for the public; 3) the assessment of commercially available lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) antibody test kits, development of a simple and inexpensive test for field application, and establishment of WHO reference reagents; 4) cooperation with Member States in the development of national programs and actions for the containment of LAV/HTLV-III infection; 5) advice to Member States on the provision of safe blood and blood products; and 6) coordination of research, particularly on a) the development of therapeutic agents and vaccines and b) simian retroviruses. Recommendations to increase the safety of blood and blood products include education of the public and donors about AIDS, exclusion of donors from high-risk groups, and avoidance of nonessential use of blood and blood products. Where feasible, it is recommended that donors should be screened for LAV/HTLV-III antibody. All sera reactive in an enzyme-linked immunosorbent assay (ELISA) should be tested in another system. WHO can play a major role in coordinating collaborative action in the area of vaccine development and antiviral agents, as well as serving as a clearing house for information.
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  23. 23

    Update: acquired immunodeficiency syndrome--Europe.

    Brunet JB; Ancelle R

    MMWR. Morbidity and Mortality Weekly Report. 1986 Jan 24; 35(3):35-46.

    As of September 30, 1985, 1573 cases of acquired immunodeficiency syndrome (AIDS) had been reported by the 21 European countries that are participants in the World Health Organization (WHO) European Collaborating Center on AIDS. An average increase of 27 new cases/week has been noted. Of the total cases, there have been 792 deaths, for a case-fatality rate of 50%. The greatest increases in numbers of AIDS cases have occurred in the Federal Republic of Germany, France, the UK, and Italy. The highest rates exist in Switzerland (11.8), Denmark (11.2), and France (8.5). 65% of European AIDS patients have 1 or more opportunistic infection. 20% had Kaposi's sarcoma, alone, and 13% had opportunistic infections with Kaposi's sarcoma. 92% of cases have involved males, and 42% fall into the 30-39-year age group. Of the 1330 (85%) cases involving Europeans, 78% were homosexual or bisexual men, 70% were intravenous drug abusers, and 2% had both these risk factors. Africans have contributed 10% of European AIDS cases. A questionnaire on public health measures related to blood transfusion found that systematic screening of blood donors for lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) antibodies became effective in 16 of the 21 European countries between June-November 1985. Screening is compulsory in 13 countries. The test used is the enzyme-linked immunosorbent assay (ELISA). Portugal is the only country to have organized a national register of seropositive blood donors, although Norway is considering such a register. Methods to exclude donors at risk have been taken in all the countries except Czechoslovakia, Finland, and Portugal. Although male homosexuals account for 69% of reported AIDS cases in Europe, there has been an increase in cases among intavenous drug abusers from 2% of the total in July 1984 to 8% in September 1985. Over 40% of AIDS cases in Italy and Spain occurred in this group. Moreover, several studies carried out in 1985 showed a high frequency (20-50%) of serologic markers of LAV/HTLV-III infection in intravenous drug abusers.
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  24. 24

    Acquired immunodeficiency syndrome: meeting of the WHO Collaborating Centres on AIDS.

    MMWR. Morbidity and Mortality Weekly Report. 1985 Nov 8; 34(44):678-9.

    This report summarizes positions developed at a September 1985 meeting of Collaborating Centers on Acquired Immunodeficiency Syndrome (AIDS). Among these positions were the following: 1) the only practical methods currently available for routine, large-scale AIDS testing involve screening for antibodies to lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III); 2) all sera reactive for LAV/HTLV-III antibodies should be confirmed by immunoprecipitation or immunoblot; 3) transfusion-associated AIDS can be eliminated by screening all units of blood and excluding donors from high-risk groups; 4) reuse of unsterile needles should be discouraged; 5) successful therapy may involve a combination of antiviral agents and substances that enhance immune responsiveness; 6) new antiviral drugs require careful study using the procedures of classical drug evaluation protocol, under the guidelines of national control authorities; 7) placebo-controlled studies in patients with mild forms of disease due to LAV/HTLV-III infection should be encouraged, since such studies will provide an answer on the efficacy of a drug more quickly and with fewer cases than the use of historic controls; 8) the prevalence of AIDS will depend heavily on the success of risk reduction programs based on public information and education; 9) the administration of live-virus vaccines could pose a theoretical risk to immunodeficient patients, although no adverse reactions have been detected to vaccines in individuals with antibody to LAV/HTLV-III; 10) T-lymphotropic retroviruses of simians provide potentially valuable models for studying the treatment of AIDS; and 11) an important aspect of World Health Organization activities on AIDS will be the collection of data on the incidence of the disease or its causative virus.
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