Kapita Bila

EVALUATION OF A CLINICAL CASE-DEFINITION OF ACQUIRED IMMUNODEFICIENCY SYNDROME IN AFRICA

A provisional clinical case-definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organisation (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case-definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. These results support the use of the WHO clinical definition for AIDS in Africa. However, since HIV prevalence and disease expression vary, similar evaluations should be carried out in different regions.

Human Immunodeficiency Virus Infection among Employees in an African Hospital

To define the prevalence and course of human immunodeficiency virus (HIV) infection, we examined prospectively a cohort of 2002 adult hospital workers in Kinshasa, Zaire. From 1984 to 1986 the prevalence of HIV infection increased from 6.4 percent to 8.7 percent. Over the two years there was a cumulative incidence of new HIV infection of 3.2 percent. The prevalence was higher among women (16.9 percent) and men (9.3 percent) under the age of 30 than among women (9.0 percent) and men (6.2 percent) over 30. Prevalence rates were similar among physicians (5.6 percent), laboratory workers (2.9 percent), and clerical workers (7.9 percent), but they were higher among female nurses (11.4 percent) and manual workers (11.8 percent). Despite marked differences in the intensity of nosocomial exposure, female nurses had similar infection rates on the female internal medicine ward (9.9 percent), in pediatrics (10.8 percent), and in the delivery room (10.7 percent). The attributable risk of HIV infection from a transfusion was 5.9 percent. Neither medical injections nor scarification was a risk factor for HIV infection. Of the 101 seropositive asymptomatic employees in the 1984 survey, 16 percent had AIDS-related complex, 3 percent had AIDS, and 12 percent had died of AIDS by 1986. Previous studies have revealed a seroprevalence of 8.4 percent among women attending an antenatal clinic near the hospital in 1984 and 1986, and of 5.8 percent (in 1984) and 6.5 percent (in 1986) among men donating blood at the hospitals blood bank. We conclude that there is a continuing high prevalence of HIV infection among hospital workers in Kinshasa, Zaire, which appears to be representative of that in the community and not nosocomial.

Natural history of human immunodeficiency virus infection in Zaire.

The natural history of human immunodeficiency virus (HIV) infection in Zaïre was determined by identifying in October, 1984, 125 seropositive hospital personnel without signs or symptoms and 145 age and sex matched seronegative controls from the same population. Between July, 1985, and February, 1986, 67 seropositives, including 38 men and 29 women, and 113 seronegatives were interviewed and examined by an observer who did not know their serological status. The acquired immunodeficiency syndrome (AIDS) had developed in 1 seropositive and no seronegatives (rate difference, 1.3/100 person-years [py]; 95% confidence interval 0-3.3/100 py); AIDS-related complex or generalised lymphadenopathy had developed in 8 seropositives (12%) and 1 seronegative (1%) (rate ratio, 13.2; 95% confidence interval 1.3-134.6); and minimal lymphadenopathy had developed in 19 seropositives (28%) and 8 seronegatives (7%) (rate ratio, 3.9; 95% confidence interval 1.8-8.4). These data provide the first estimates for rates of progression to AIDS or AIDS-related conditions among healthy HIV seropositive heterosexual adults. Rates observed in this study are similar to those reported in US or European homosexual or bisexual men.

Cutaneous Reactions to Trimethoprim-Sulfamethoxazole in African Patients with the Acquired Immunodeficiency Syndrome

Excerpt To the editor: Trimethoprim-sulfamethoxazole has been shown to be effective treatment forPneumocystis cariniipneumonia (1) and probably as prophylaxis of such infection (2). However, its us...

Orthostatic hypotension in HIV infection in Africa

Clinicians interviewed and conducted a physical examination of 109 people to determine the prevalence of orthostatic hypotension (decline in systolic blood pressure of > 20 mmHg or syncope when standing up) in an African population including people with HIV infection. 40 people were outpatients of a clinic at Mama Yemo Hospital in Kinshasa Zaire. Another 50 were patients in the hospitals department of internal medicine. 45% of the outpatients and 54% of the inpatients were HIV seropositive. The remaining 19 people were healthy HIV-seronegative factory workers and their spouses. HIV-infected patients were significantly more likely to experience orthostatic hypotension than the HIV-seronegative controls (9/45 vs. 2/45; p = .02) and than the healthy HIV seronegatives (0; p < .01). These findings indicated that like Caucasians orthostatic hypotension is linked to HIV infection in Africans. More research is required to identify the role of the dysfunction of the autonomic nervous system in bringing about orthostatic hypotension.