bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful discontinuation of fluconazole as secondary prophylaxis for cryptococcosis in AIDS patients responding to highly active antiretroviral therapy
Authors: Sheng W H , Hung C C , Chen M Y , Hsieh S M , Chang S C
Published: October 2002

Seven AIDS patients with disseminated cryptococcosis who had had immune reconstitution following highly active antiretroviral therapy (HAART) had discontinued their secondary antifungal prophylaxis to prevent relapse of Cryptococcus neoformans infection. The median CD4+ count was 236 cells/ µL (range, 117-404 cells/ µL; mean, 247 cells/ µL) and the plasma viral loads were undetectable in five patients at discontinuation of antifungal prophylaxis. No relapse of cryptococcosis was detected in these patients after a median observation duration of nine months (range, 5.5-4.1 months, mean, 14.6 months) following discontinuation. Our data and review of the literature suggest that discontinuation of fluconazole prophylaxis is safe in patients with reconstitution of immunity following initiation of HAART.
Oral ganciclovir: a new option for patients with CMV retinitis
Authors: Fisher Martin , Barton Simon
Published: October 2002

Cytomegalovirus retinitis is a major cause of morbidity in patients with AIDS. The conventional treatment approach has involved insertion of a central venous catheter and intravenous administration of ganciclovir and/or foscarnet. This has been associated with systemic toxicity, line-related sepsis, and implications for patient quality-of-life. An oral formulation of ganciclovir has now been licensed for use as maintenance therapy in CMV retinitis. Multicentred trials comparing oral and intravenous ganciclovir have suggested that although the efficacy may be marginally reduced with the oral formulation, the associated toxicity is significantly lower. With careful and informed decision-making by both clinician and patient, the opportunity exists to enhance the quality of life in this patient group.
Treatment of chancroid with azithromycin
Authors: Ballard R C , Ye Htun , Matta A , Dangor Y , Radebe F
Published: October 2002

A randomized, comparative study undertaken in Nairobi, Kenya and a non-comparative evaluation undertaken in Carletonville, South Africa have both shown that a single oral dose of azithromycin 1 g is effective in the treatment of the genital ulcer disease (GUD), chancroid, with cure rates of 89% and 92% recorded respectively. While treatment failure was associated with human immunodeficiency virus seropositivity and lack of circumcision in Kenya, no such association could be found in the South African study. In both series, azithromycin treatment resulted in cure of both Haemophilus ducreyi culture-positive and culture-negative cases of GUD, including two cases subsequently diagnosed as lymphogranuloma venereum. A combination of single-dose azithromycin with single-dose benzathine penicillin may provide effective ‘single-visit’ syndromic treatment for GUD in many developing countries.
Longitudinal studies of children born to HIV-1 antibody positive Filipino commercial sex workers (CSW): diagnostic dilemmas
Authors: Manaloto C R , Caringal L T , Santiago E G , Basaca-Sevilla V , Perrault J G , Hayes C G , Anthony R L
Published: October 2002

Fifteen term babies born to 12 HIV-1 antibody positive Filipino CSW have been m onitored for signs and sym ptom s of HIV-1 infection. Eleven babies were enrolled in the study within the first 6 months after birth; 4 others were enrolled at 4, 9, 11 and 21 months of age respectively. Every 3 months after enrolm ent, each baby received a physical examination, serum was tested for HIV-1 antibodies and p24 antigen and peripheral blood mononuclear cells were cultured for isolation of virus. After a m ean follow-up period of 39.3 months (range 7-72 months), virus isolation and serum p24 antigen assays confirmed that 2 babies have been infected with HIV1. If the 4 babies less than 18 months of age were excluded, the vertical transmission rate was 18.2%. Seven babies who have been monitored for a minim um of 25 months (range 31-60 m onths) lost their maternal antibodies but 6 of them subsequently developed indeterm inant Western blots (WB); reactivity to p24 and/or gp120/160 but no reactivity to gp41. Of the remaining 6 babies, still less than 25 months of age (range 7-24 months), 2 lost their maternal antibodies within one year. The other 4 continued to recognize either p24 or gp120/160 well after the accepted 15-month period for loss of maternal antibody. Although a diagnosis could not be established upon the basis of these laboratory findings, clinical observations (failure to thrive, anergy, persistent generalized lymphadenopathy and recurrent pneumonias) mimicked HIV-1 infection. However, because these clinical features are common among m any babies in the developing world, their usefulness in supporting a diagnosis of perinatal HIV-1 infection is limited.
Patients with genital warts: how are they managed by general practitioners?
Authors: Estcourt C S , Higgins S P , Hall J , Hillier V F , Chandiok S , Woolley P D
Published: October 2002

This study was carried out to assess the management by general practitioners of patients with genital warts. An anonymized postal questionnaire was sent to 2060 general practitioners in the north west of England; 1260 (61.2%) completed questionnaires were returned. A total of 76.69% of GPs saw one or more cases per quarter. Of 468 (37.1%) GPs who managed patients in-house, 393 (83.9%) used podophyllin of concentration between 0.5 and 50%; 169 (43%) did not specify the podophyllin concentration and 112 (23.9%) used podophyllotoxin. Of 395 GPs (31.3%) prescribing patient self-treatment, 259 (65.6%) prescribed podophyllin, but 60.23% did not specify the concentration; 134 (33.9%) prescribed podophyllotoxin. Screening for selected sexually transmitted infections (STIs) was performed by 258/618 (41.7%) GPs. Only 74 (11.97%) screened for Chlamydia trachomatis and Neisseria gonorrhoeae and Trichomonas vaginalis . Partner notification was advised by 1138 (90.3%) and condom use by 1027 (81.5%). Only 333 (26.4%) referred all patients to GUM departments. Many GPs manage patients in-house, most using podophyllin solutions which vary in concentration, are non-standardized and potentially hazardous. Most GPs who instigate patient self-treatment prescribe podophyllin which is not licensed for this usage. Podophyllotoxin 0.5% is a safe, effective alternative. Few non-referring GPs screened for the 3 common STIs, thus putting patients at risk of complications such as pelvic inflam matory disease. Non-referral of patients with genital warts to GUM departments may have costly medical and financial consequences.
Grey case
Authors: Sherrard Jackie
Published: October 2002

Grey Cases These are clinical cases which are intended to be a focus for discussion at regional AGUM meetings, clinical meetings and teaching. Therefore, no answers are provided.
Clinical features, outcome and survival from cerebral toxoplasmosis in Edinburgh AIDS patients
Authors: Laing R B S , Flegg P J , Brettle R P , Leen C L S , Burns S M
Published: October 2002

Nineteen cases of cerebral toxoplasmosis (CTOX) are reported from a group of Edinburgh AIDS patients. All patients were severely immunodeficient at the time of presentation with CD4 count <50 cells/mm 3. Thirteen patients had suffered a previous AIDS-defining illness. In Edinburgh, CTOX has developed in 48% of patients who are seropositive for toxoplasma and have a CD4 count <50 cells/mm3. It is estimated that at least half of the toxoplasma seropositive patients will develop CTOX if they survive for 21 months after reaching a time in their illness when the CD4 count=50 cells/mm 3. The incidence of CTOX in toxoplasmaseronegative patients with a CD4 count <50 cells/mm 3 is 1.3%. All patients showed improvement on treatment and there was no correlation between clinical or radiological features and patient survival. Those patients unable to tolerate first choice anti-toxoplasma therapy had a significantly shorter survival than the remainder but there was no single therapeutic regimen which conferred a survival advantage. Eighteen patients had died at the time of study and the median survival following diagnosis of cerebral toxoplasmosis was 10 months (range 3-38 months). Postmortem examination of the brain was available in 8, 4 of whom had concomitant cerebral lymphoma. The survival from AIDS or CD4 count=50 cells/mm 3 did not differ significantly between those with treated CTOX and a control group who had no toxoplasma infection, suggesting that treatment is reasonably effective. CTOX is a disease associated with severe HIV-related immunodeficiency and, in those with a CD4 count <50 cells/mm 3, occurs more than 35 times as frequently in toxoplasma-seropositive than toxoplasma-seronegative patients. Treatment is effective but the outcome of treated disease cannot be predicted from presenting clinical or radiological features. Concomitant space-occupying cerebral pathology is evident in 50% of post-mortem examinations.
Characterizing patients with multiple sexually acquired infections: a multivariate analysis
Authors: Pakianathan M. R. , Ross J. D. C. , McMillan A.
Published: October 2002

It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently hence necessitating screening in individuals attending GenitoUrinary Medicine (GUM) clinics. However there are few data on individuals with more than one concurrent STD. Individuals attending the GUM Department in the Royal Infirmary of Edinburgh between 1990 and 1994 with the diagnosis of HIV infection, genital warts, genital herpes, non-specific genital infection (NSGI), gonorrhoea and syphilis were included in the study. A multivariate comparison was made between those presenting with multiple concurrent STDs and a control group comprising individuals with a solitary STD with respect to year of attendance, social class, location of acquisition of infection, sex, sexual orientation and age using a logistic regression model. A total of 680 of 9265 patients in the study period had more than one concurrent STD. Individuals in lower socio-economic class were at higher risk and older individuals at lower risk of multiple concurrent STDs. Multiple sexually acquired infections are common in individuals who attend GUM clinics. Age and socio-economic class were the only significant variables. Identification of populations at highest risk for multiple infection can direct interventions against all STDs.
Bacterial infections in HIV: the extent and nature of the problem
Authors: Brettle R P
Published: October 2002

Leucopenia and neutropenia in HIV appears to be much less common than in the context of haematological malignancies although severe neutropenia 9 (< 0.75 10 /l) occurs in as many as 70% of patients with AIDS often related to concomitant drug therapy. In addition to low numbers of neutrophils there is also some evidence of defective neutrophil function in HIV/AIDS (chemotaxis, bacterial killing, phagocytosis and superoxide production). However the frequency and importance of these defects is as yet not known because simple and reproducible tests of neutrophil function are not yet available to the majority of clinicians. Despite the relative scarcity of severe neutropenia in early HIV, bacterial sepsis is a major clinical problem which usually manifests itself as either pneumonia, bacteraemia or both at a frequency of between 8-20 per 100 person years depending upon location, risk activity etc. Amongst drug users, the inhalation of recreational drugs particularly after Pneumocystis carinii pneumonia (PCP) has been shown to be a major risk factor for pneumonia. The incidence of bacterial sepsis in patients with AIDS is more difficult to determine since it is often overshadowed by other more dramatic opportunistic infections. However, throughout the course of AIDS, bacterial infections are a common problem particularly in the presence of one or both of concomitant drug therapy and indwelling intravenous lines utilized in late stage disease. Consequently, since bacterial infections are common and cause considerable morbidity and mortality they should be considered in the differential diagnosis of most presentations.
Recombinant human interferon- for condylomata acuminata: a randomized, double-blind, placebo-controlled study of intralesional therapy
Authors: Bornstein Jacob , Pascal Bruno , Zarfati Doron , Goldschmid Nimrod , Abramovici Haim
Published: October 2002

To assess the efficacy of a novel glycosylated mammalian cell derived recombinant human interferon- (r-hIFN--1a) in the intralesional treatment of genital condylomata acuminata. The study was randomized, double-blind and placebo-controlled. Patients ( n =60) with up to 8 distinct condylomata acuminata were randomized to receive either one million international units (IU) of r-hIFN--1a or placebo intralesionally into each lesion, 3 times a week, for a total of 9 occasions. Biopsies were taken from each patient before enrolment to allow human papillomavirus (HPV) testing, and patients were tested for the development of anti-IFN- antibodies. Efficacy was assessed by measuring the complete response rate 3 months after treatment. The complete response rate was not significantly better with r-hIFN--1a than with placebo. However, after 3 months, 73.3% of patients treated with r-hIFN--1a had experienced at least a partial response to treatment, compared with 33.3% of placebo-treated patients. At 19 days and 6 weeks, r-hIFN--1a produced a significantly larger reduction in the area of condylomata. Lesions with detectable HPV 6 or 11 showed a trend towards a better response rate to treatment with rhIFN--1a than lesions where no HPV DNA was detected. The treatment was well tolerated. In the 5 patients who developed non-neutralizing anti-IFN- antibodies, therapeutic efficacy was not compromised. Intralesional r-hIFN--1a was effective in the reduction of the size of genital condylomata acuminata.
Relationship of genital wart burden to therapeutic response to fluorouracil/epinephrine injectable gel
Authors: Swinehart J M , Korey A , Orenberg E K
Published: October 2002

Summary: The efficacy of a single cycle of a new therapy for genital warts, intradermal fluorouracil/epinephrine (5-FU/epi) injectable gel, has been evaluated in 2 large pivotal trials; the objective of this study was to evaluate a second cycle of treatment. Twenty-two patients with total wart areas of 5-447 mm 2 were treated with up to 2 cycles of 6 treatments of 5-FU/epi gel. After the first cycle of treatments, patients with warts showing a partial response or no response or new warts were continued into a second cycle. Seventy-three per cent (16/22) of patients had complete responses. Patients with total wart areas respond completely in the first cycle of treatment (average 4.7 treatments). Patients with numerous warts or large total wart areas ( 100 mm 2) required an average of 7.5 treatments to achieve a complete response. Thus, a second treatment cycle may be appropriate for difficult-to-treat patients with numerous warts or large total wart areas. 100 mm 2 tended to >
Improvement in AIDS knowledge, perceptions and risk behaviours over a short period in a rural community of Senegal
Authors: Enel Emmanuel Lagarde Gilles Pison Catherine
Published: October 2002

The objective of this paper is to assess knowledge, perceptions and behavioural changes in response to AIDS in a rural community in the south of Senegal, comparing 2 cross-sectional surveys using standardized questionnaires and performed in 1990-1992 and 1994. An AIDS-related knowledge score was built using 4 questions about routes of HIV transmission, ranging from 0 to 4. The score increased between the 2 surveys from 1.6 to 2.1 for men ( P =0.006) and from 0.8 to 2.6 < for women ( P 10 4). The proportion of those who responded 'I don't know' to the 4 questions dealing with routes of AIDS transmission decreased from 24% to 14% on the average for men and from 66% to 20% on the average for women. The proportion of men who declared casual sex partners in the past 12 months decreased from 39% to 21% ( P =0.01). However, the proportion remained stable for women (from 15% to 18%). These results show that despite a relatively low level of HIV infection (0.8% of all adults), AIDS-related knowledge increased and at-risk behaviour decreased in a rural area of west Africa.
Indirect calorimetry, body composition and small bowel function in asymptomatic HIV-seropositive women
Authors: Sharpstone D , Ross H , Hancock M , Phelan M , Crane R , Gazzard B
Published: October 2002

Extrapolation of data from energy balance studies in HIV-seropositive men to HIV-seropositive women may be inaccurate due to gender differences in body composition, hormones and metabolism. If women have a different metabolic response to the human immunodeficiency virus (HIV), nutritional advice may differ from HIV-seropositive men. Ten asymptomatic HIV-seropositive women were matched with 10 heterosexual female controls from low-risk groups. Subjects and controls had assessment of energy and protein intake, resting energy expenditure (REE) and substrate oxidation, small bowel absorption and permeability and body composition. There were no significant differences in REE, substrate oxidation and body composition. Energy and protein intake and small bowel permeability were increased and sugar absorption decreased in HIV-seropositive women (all P 0.05). Unlike asymptomatic HIV-seropositive men, asymptomatic HIV-seropositive women do not have significant alterations in metabolism or body composition. Therefore, nutritional advice may need to vary according to the gender of the asymptomatic HIV-seropositive subject. <
A multidistrict audit on the management of Chlam ydia trachomatis in genitourinary medicine clinics in Yorkshire
Authors: Monteiro Eric F , Harris Janet , Gilliatt Paul
Published: October 2002

Summary: Nine genitourinary clinics (one teaching hospital and 8 district general hospitals) within the Yorkshire Deanery audited the management of uncomplicated genital chlamydial infections in male and female patients attending between January and December 1995. Standards set included: 100% of chlamydia-positive patients to be treated within 2 weeks of diagnosis; 100% of patients to return for test of cure within one month of treatment; 100% of patients to be referred for contact tracing. Four hundred and thirty-six of a total 1356 cases were audited. Eighty-nine per cent received treatment within 2 weeks; 64% returned for a test of cure within one month; 93% were referred for contact tracing. Changes in practice and a regionwide multidisciplinary audit initiative resulted from the study.
Measures and meanings: outcome measures in the management of sexually transmitted infections
Authors: Welch Jan
Published: October 2002

Summary: Applicable outcome measures in genitourinary medicine (GUM) include compliance with clinical standards of care, symptom control, cure rates of infections, decreased incidence of infections, lack of complications, increase in patients' knowledge or satisfaction, and number of partners treated. Measuring these may be easy in the short-term but result in information of limited usefulness. Longer-term outcomes may be more meaningful, but harder-or impossible-to obtain. Some outcome measures are affected by case mix, so differences between patients may be as much as or more relevant than the care received. Quantitative and qualitative measurements of patient satisfaction are straightforward to obtain and essential in examining care delivery, but may be unrelated to desired clinical outcomes for individuals or populations. Compliance with clinical standards is easy to measure, relatively independent of case mix, and useful if standards are evidence-based and validated. The role and applicability of outcome measures are discussed.
HBV and HIV screening, and hepatitis B immunization programme in the prison of Marseille, France
Authors: Rotily M , Vernay-Vaisse C , Bourliere M , Galinier-Pujol A , Rousseau S , Obadia Y
Published: October 2002

Summary: This study estimated the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) serological markers among inmates and evaluated inmates' compliance with an HBV immunization programme. During the mandatory consultation at the sexually transmitted disease (STD) clinic of the Marseille Prison (HIV counselling, and syphilis/HIV screening), physicians offered serological testing (anti-HBs, anti-HBc, HbsAg, anti-HIV) and Engerix B vaccination to each entrant. The number participating in the survey is 391/411 (89%); 75% were aged 18 to 35 years and 79% were men; 42% reported having had multiple sexual partners during the last 12 months. Report of an intravenous drug user (IDU) sexual partner was more frequent among women than men (22% vs 8%). Injecting drug use over lifetime was reported by 23%; 27% declared having shared their injection equipment during the last 12 months. 124/267 (32%) had an HBV marker: anti-HBs only (immunized): 2.3%; anti-HBs and anti-HBc : 21.7%; anti-HBc only: 6.4%; HBsAg : 1.3%. The HIV seroprevalence was 6% (21% among IDUs). This survey underlines the high HBV and HIV seroprevalence among prisoners and the high proportion of inmates at risk for these infections. There is an urgent need for immunization and education programmes in this population. It demonstrates an HBV immunization programme is feasible and accepted by inmates and staff members.
Clinical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers
Authors: Dorrell L , Hassan I , Chakraverty P , Ong E
Published: October 2002

Summary: To investigate the clinical and serological responses to an inactivated influenza vaccine (split-virion A/Singapore/6/86-like strains H1N1 (15 ug HA), A/Beijing/353/89-like H3N2 (15 ug HA) and B/Yamagata/16/88-like strain (15 ug HA): MFV-JECT, Merieux, UK) in persons with HIV infection, diabetes, obstructive lung diseases, elderly adults and healthy volunteers. Forty-nine HIV-infected persons received 2 doses of the vaccine at one-month intervals; 34 healthy volunteers, 30 elderly persons, 29 with insulin and non-insulin diabetes and 14 with obstructive airways diseases were vaccinated with one single dose between October 1992 to January 1993. Serological testing of antibody responses was done using haemagglutination assay. beta2-microglobulin in HIVinfected persons was measured using radioimmunodiffusion between 1st and 2nd dose. Fructosamine levels in diabetic persons were assessed for diabetic control and peak expiratory flow rate (PEFR) was self monitored in persons with lung diseases. All groups apart from the elderly filled in a symptom score chart for the first 5 days following vaccination. A 4-fold rise in titre equal to or more than 1:64 to all the 3 antigens occurred in 20 (58.8%) of healthy volunteers compared with 13 (44.8%) diabetics, 5 (35.7%) with lung diseases, 10 (33.3%) elderly and 13 (26.5%) with HIV infection. A significant correlation of serological response to number of CD4 count in persons with HIV infection was noted (H1N1 P =0.0013, H3N2 P =0.025, BYAM P =0.0018). Mean beta2- microglobulin levels did not change significantly post 1st and 2nd vaccination. Mean fructosamine level did not change significantly. There was no significant change in PEFR. The vaccine was well tolerated. Persons with HIV infection and low CD4 count do not serologically respond well to influenza vaccine even with 2 doses compared to the other 4 groups. The other 4 groups had adequate protective serologic responses. The vaccine was well tolerated in all groups.
Congenital syphilis in Harris County, Texas, USA, 1990-92: incidence, causes and risk factors
Authors: Risser William L , Hwang Lu-Yu
Published: October 2002

Summary: From local health department data, we determined the 1990-92 incidence of congenital syphilis (CS) in Harris County, Texas, USA, applying for the first time the Centers for Disease Control and Prevention (CDC) 1990 surveillance case definition to a population-based sample. We also evaluated factors that discriminated between women whose infants were or were not cases. The incidence of CS per 1000 live births was 3.2 in 1990, 4.6 in 1991 and 4.2 in 1992. Because of failure to apply part of the case definition, the local health department reported only 60% (418/694) of the cases that we identified. In the multivariate analysis, the significant factors for CS were lack of prenatal care and late latent syphilis. No factor identified high-risk women to target for special public health interventions. Improved laboratory services and better education of local providers and surveillance workers will solve some problems in the diagnosis and therapy of syphilis during pregnancy. Ambiguity in the CDC's case definition of CS needs correction.
Young women's sexual risk taking behaviour: re-visiting the influences of sexual self-efficacy and sexual self-esteem
Authors: Seal A. , Minichiello V. , Omodei M.
Published: October 2002

Summary: This study investigates the influences on young women's sexual risk taking of (a) attitudes such as sexual self-efficacy and sexual self-esteem and (b) personal and sexual characteristics, such as age, the age of first sexual experience, the number of sexual partners and reported overall amount of sex. Three hundred and thirty-one young women participated in this study. With respect to regular sexual relationships, the results show that risk taking behaviour is directly and positively associated with sexual self-esteem. The effect of sexual self-efficacy on risk taking in regular relationships, however, is indirect and positive, being mediated by the overall amount of sexual activity. In contrast, with respect to casual sexual relationships, risk taking behaviour is negatively associated with self-esteem and positively associated with sexual self-efficacy. In addition, sexual self-esteem influences casual risk taking indirectly and positively, the effect being mediated by the overall amount of sexual activity. The findings in relation to sexual self-esteem and sexual self-efficacy are contrary to the expectations that these variables would be negatively associated with sexual risk taking behaviours. The implications for safe sex education are discussed.
Application of 'Clearview chlamydia' for the rapid detection of cervical chlamydial antigen
Authors: Woolley P D , Pumphrey J
Published: October 2002

In a study to evaluate the Clearview chlamydia test in a genitourinary medicine clinic, the sensitivity and specificity were 76.4% and 99.4% respectively when compared with the DAKO IDEIA chlamydia test processed in a department of medical microbiology. The time taken to perform and read the Clearview chlamydia test 'on site' did not interfere with the normal routine functioning of the clinic and the nurses who performed it as part of their routine duties found it simple and easy to use.
Prevalence of Mycoplasma genitalium in asymptomatic men in Japan
Authors: Uno M , Deguchi T , Saito A , Yasuda M , Komeda H , Kawada Y
Published: October 2002

We aim to clarify the prevalence of Mycoplasma genitalium in asymptomatic men in Japan. First-catch urine specimens were obtained from 187 asymptomatic Japanese men and examined for the presence of M. genitalium using a polymerase chain reaction (PCR)-based assay. Two (1.1%) of 187 first-catch urine specimens were positive for M. genitalium. The prevalence of M. genitalium in urine specimens of asymptomatic men in Japan is lower than that in asymptomatic men in the UK (6%) and Denmark (9%).
Infection with HIV, syphilis and hepatitis B in Ethiopia: a survey in blood donors
Authors: Rahlenbeck S I , Yohannes G , Molla K , Reifen R , Assefa A
Published: October 2002

Sera of all male donors appearing at the blood bank of a regional hospital in Northwest Ethiopia in 1994 (n=1022) and 1995 (n=1164), were screened for the presence of human immunodeficiency virus (HIV-1) and treponemal antibodies. Additionally, screening for hepatitis B surface antigen (HBsAg) was carried out on 549 consecutive sera. In 1995, the crude seroprevalence of HIV-1 infection and syphilis was 16.7% and 12.8%. Seroprevalence of HBsAg was 14.4%. HIV and syphilis seroprevalence was highest in soldiers (30.6% and 20.9%) and daily workers (18.8% and 13.5%), and lowest in farmers (8% and 6.7%). However, farmers had the highest rate of HBsAg (18.8%). HIV-positive donors had an increased risk for being positive for syphilis antibodies (OR=3.69, 95% CI=2.69-4.96), but not for HBsAg (OR=0.79, 95% CI=0.361.67). The data indicate that (i) the HIV epidemic has not yet reached a plateau phase in Ethiopia, and (ii) the transmission and epidemiology of HBsAg in Ethiopia is different from that of HIV and syphilis.
Determination of factors associated with condom use among women infected with human immunodeficiency virus
Authors: Clark Rebecca A , Kissinger Patricia , Bedimo Ariane L , Dunn Patrice , Albertin Helena
Published: October 2002

Summary: To better understand potential barriers to condom use and the sexual behaviour of women infected with human immunodeficiency virus (HIV), an anonymous self-administered survey was performed on a convenience sample of 83 predominantly single HIV+ women. Most women had only one sexual partner who usually knew of the subject's serostatus. Only a minority of partners (26%) were known to also be HIV infected. Subjects were surprisingly more likely to use condoms with their main partner as opposed to other partners. Factors found to be associated with condom non-use included younger age, low education level, partner HIV+, history of a sexually transmitted disease (STD), and use of drugs or alcohol during sex. Although most subjects indicated the decision was mutual when deciding not to use a condom, 20% stated it a was a partner decision. Future intervention efforts should target these identified high-risk individuals and optimally involve the partners of HIV-infected women.
The sexual behaviour of international travellers at two Glasgow GUM clinics
Authors: Carter Simon , Horn Kate , Hart Graham , Dunbar Martin , Scoular Anne , Macintyre Sally
Published: October 2002

A survey of patients attending 2 Glasgow genitourinary medicine (GUM) clinics was conducted in 2 3-month periods in 1993 and 1994. Three hundred and twenty-five attendees who had travelled abroad in the preceding 3 months completed anonymous self-administered questionnaires about their sexual behaviour during these recent journeys abroad. There were 112 women and 213 men (185 heterosexuals and 28 homosexuals). Twenty-two (19.6%) women, 56 (31%) heterosexual men and 13 (42%) homesexual men had a sexual contact with a new partner while abroad. Of those who had had a new sexual contact abroad, 11 women (50% of those who had sex with a new partner) and 33 heterosexual men (59% of those who had sex with a new partner) were inconsistent users of condoms. Analysis of data found that homosexual and heterosexual men, and business travellers, are at increased risk of exposure to sexually transmitted diseases, including HIV infection, and should be targeted with safer sex health promotion prior to travel.
Case management and patient reactions: a study of STD care in a province in Zambia
Authors: Hanson S , Engvall J , Sunkutu R M , Kamanga J , Mushanga M , Hojer B
Published: October 2002

Sexually transmitted disease (STD) case management was evaluated through observation and interviews at 2 urban and 4 rural health centres and 2 district hospital STD clinics in one urban and 2 rural districts in Central Province, Zambia. The analysis was limited to 59 patients (42 men and 17 women) who paid first visits for their disease and were managed by a clinical officer. The evaluation suffered from the lack of a standard for case management. Results showed that the patients engaged in risky sexual behaviour without being aware of the risks. At the health institutions, few patients were informed about condoms, the risk of HIV, and abstinence from sex during treatment and few were asked to notify their partners. Clinical officers with special STD training performed better than others but sill informed only one-fifth of the patients. Few clinical officers managed patients according to the syndromic approach recommended by the STD control programme.
Radioactively labelled diethylene triamine penta acetate lung scan in Pneum ocystis carinii pneumonia and asymptomatic HIV-positive patients
Authors: Dimian Caroline O , O'Doherty Michael J , Asboe David , Page Christopher J , Entwisle Kate , Bingham James S
Published: October 2002

The objective of this study is to establish normal ranges for the assessment of lung permeability, using 99mTc DTPA (diethylene triamine penta acetate) aerosol by measuring the half-time of transfer from the lung in asymptomatic HIV-positive patients. Also to audit the use of the test in the clinical management of outpatients with symptoms suggestive of Pneumocystis carinii pneumonia (PCP). A retrospective analysis of data from outpatients' notes for the audit of symptomatic patients, and prospective acquisition of 'normal' data for HIVpositive asymptomatic patients who were non-smokers and smokers was performed. Over a period of 8 years, DTPA scans were performed on 400 asymptomatic HIV-positive patients (121 non-smokers and 279 smokers) and 188 symptomatic HIV-positive patients with symptoms suggestive of PCP. A biphasic curve of transfer of 99mTc DTPA with a half-time of less than 4 min, was considered diagnostic of PCP. The mean half-times ( SEM) for asymptomatic non-smokers was 61.4 3 min and for smokers was 21.9 0.8 min. In the symptomatic patients, 106 were treated for PCP and in 97 (91.5%) of these, the transfer was biphasic. Of the remaining 82 patients with respiratory pathology other than PCP, 71 (86.6%) had normal scans. The results show that smokers may have abnormal baseline scans 16/ 279 (5.7%) and therefore a baseline scan before symptoms should be recorded or a higher false positive rate can be expected. The test is however highly sensitive for the detection of PCP and allows the attending physician to initiate PCP treatment without delay.
High HIV prevalence, low condom use and gender differences in sexual behaviour among patients with STD-related complaints at a Nairobi primary health care clinic
Authors: Holmes J O , Ghee A E , Kihara A N , Krone M R , Plummer F A , Fisher L D , Holmes K K
Published: October 2002

Of 22,274 patients 12 years old attending a Nairobi primary health care (PHC) clinic, 1076 (4.8%) had STD-related complaints, of whom 980 underwent assessment of risk factors for human immunodeficiency virus (HIV) infection and infrequent condom use. Gonorrhoea, chancroid, syphilis seroactivity, trichomoniasis, or objective signs of STD were found in 78%, and HIV seropositivity in 15% of men and 19% of women. Most women were married, living with a spouse; while most men were single, or married, but living separated from a spouse, Among married men, last sex was with a female sex worker (FSW) or casual partner for 60% not living with a spouse and 26% living with a spouse ( P 0.005). Two or more partners during the past year were reported by 82% of men and 25% of women < ( P 0.001), and 55% of men and 11% of women reported the last partner was high risk. HIV seropositivity among both genders was associated with numbers of partners, and among women, with being widowed or divorced. Only 3% reported use of a condom with the last partner. Among men whose last sex was with a FSW, 74% said the reason for not using a condom was not having one. Thus, infrequent condom use, low condom availability, and gender differences in behaviour necessitate modifying development policies that separate families; and better coordination between family planning, PHC, and AIDS/STD programmes, with improved supply, social marketing and community-based distribution of condoms in high-risk settings for STD/HIV prevention. <
Isolated microscopic haematuria in the genitourinary clinic: the value of renal biopsy
Authors: Topham Peter , Young Susan , Harper Steven , Furness Peter , Riley Vincent , Feehally John
Published: October 2002

Summary: Isolated microscopic haematuria is a common finding in the genitourinary clinic. The conventional approach to investigation includes urological referral for cystourethroscopy if renal imaging is normal. However the diagnostic yield is very low; in particular urothelial malignancy at age Glomerular disease is increasingly recognized as a common cause of microscopic haematuria. In this study 50 patients with persistent microscopic haematuria detected at a genitourinary clinic underwent renal biopsy. Twelve (24%) had an abnormal biopsy-IgA nephropathy 6 (12%), thin membrane nephropathy 3 (6%), other glomerulonephritis 3 (6%). In 7 others no abnormality was found but information was incomplete as electron microscopy was unavailable. It is important to establish these diagnoses since some patients will develop progressive renal disease. In this clinical setting renal biopsy will give diagnostic and prognostic information, protects from repeated urological investigation, and allows reassurance if renal histology is normal. Renal biopsy is recommended for patients age < 40 years with persistent microscopic haematuria. An algorithm for the investigation of microscopic haematuria is presented. < 40 years is rare.
Outcomes in genitourinary medicine: whose priority?
Authors: Johnson Anne M
Published: October 2002

Summary: The primary role of genitourinary medicine (GUM) services in the UK is the treatment and control of sexually transmitted diseases (STDs). The origins of the service lie in its public health function, yet measuring outcomes locally and nationally is not straightforward. Difficulties arise from the complex interactions between sexual behaviour, the biology of STDs and the role of clinical services; from the potential consequences of the National Health Service (NHS) internal market on national STD control; and from the limitations of information and surveillance systems. This paper considers each of these areas in turn and concludes with some proposals for measuring GUM outcomes locally and nationally which might potentially satisfy the concerns of commissioners and providers.
Frequency of alcohol use and its association with STD/HIV-related risk practices, attitudes and knowledge among an AfricanAmerican community-recruited sample
Authors: Morrison Theodore C , Diclemente Ralph J , Wingood Gina M , Collins Charles
Published: October 2002

The aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an AfricanAmerican community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol ( n =201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age=37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol < =15 days and >= 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use selfefficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices.
The recent impact of antiretroviral combination therapy on CD4 counts, AIDS and death in HIV-infected persons: routine HIV surveillance in Scotland
Authors: Allardice G M , Mcmenamin J J , Parpia T , Gibbs J , Mcsharry C , Whitelaw J
Published: October 2002

Our aim was to investigate if the clinical benefits of combination antiretroviral therapy recently reported from clinical trials are reproduced in a population-based HIV surveillance scheme. This surveillance scheme is estimated to cover 90% of the HIV-positive population currently under immunological monitoring in Scotland. Our results showed a considerable reduction in new AIDS cases among this group from 107 in 1995 to 59 in 1996 and an estimated 58 in 1997 (allowing for reporting delay). There was a similar fall in deaths from 75 in 1995 to 59 in 1996 and an estimated 24 in 1997. These observations are temporally associated with increasing prescription of antiretroviral therapy in Scotland throughout 1996 and 1997. Examination of those individuals monitored in both 1996 and 1997 showed that from their first CD4 count in 1996 to their first count in 1997 there has been a median gain of 6 CD4 cells/mm 3 (95%CI 0-12) compared with a median fall of 27 CD4 cells/ mm3 (95%CI 35, 17) for those monitored in both 1995 and 1996. Highest median gains in CD4 cell counts from 1996 to 1997 were seen in those receiving triple or quadruple therapy (median gain 32 CD4 cells/mm 3). These results are further strengthened by the results of a separate longitudinal analysis showing a highly significant ( P 0.001) effect of treatment on CD4 cell loss with the highest mean CD4 gains being seen in those in triple or quadruple therapy. Our results indicate that the benefits of combination antiretroviral therapy previously seen in clinical trials are being reproduced at a population level. It remains to be seen if these benefits can be sustained in the long term.
Coronary artery disease occurring with protease inhibitor therapy
Authors: Sullivan A K , Nelson M R , Moyle G J , Newell A M , Feher M D , Gazzard B G
Published: October 2002

Protease inhibitors are increasingly recognized as causing significant metabolic abnormalities including hypertriglyceridaemia, hypercholesterolaemia, insulin resistance, diabetes, and lipodystrophy. Considerable concern has been generated by recent reports of premature coronary artery disease occurring in HIV-1 infected patients on protease inhibitor containing regimens.
Problems in physicians' classification and reporting of congenital syphilis
Authors: Yetman R J , Risser J M , Risser W L , Barth B A , Hwang L-Y
Published: October 2002

The diagnosis of congenital syphilis (CS) in newborns can only be made through a review of the mothers' testing and treatment history and through the infants' clinical and laboratory findings. We describe difficulties in the classification of CS by physicians and the health department during a recent syphilis epidemic. The records of infants identified as potential cases of CS by laboratory testing, discharge diagnosis, or health department records were reviewed by epidemiologists. The reasons for concordance and discordance in classification between the physician and the epidemiologist were determined. Congenital syphilis was identified in 126 infants. Seventeen cases were discordant and 12 cases concordant but the physician's classification was for incorrect reasons. Misclassification occurred because physicians lacked data known to the health department (n=7), health departments lacked data known to the physician (n=1), and physicians misinterpreted the case definition for CS (n=21). Suggestions for improving the diagnosis and reporting of CS are included.
Human leukocyte derived interferon-alpha in a hydrophilic gel for the treatment of intravaginal warts in women: a placebo-controlled, double-blind study
Authors: Syed Tanweer A , Ahmadpour Oliver Abbas
Published: October 2002

This placebo-controlled, double-blind study was aimed to evaluate the clinical efficacy, safety and tolerability of human leukocyte interferon-alpha (2 x 10 6IU/g) incorporated in a hydrophilic gel (hydroxyethylcellulose, 1%) to cure intravaginal warts in women. Preselected, subjects (n=60) who ranged between 18 and 50 years of age (mean 23.7), harbouring 275 vaginal warts (mean 4.6) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papillomavirus (HPV) infections were randomly divided into 2 parallel groups. A precoded tube (45g), active or placebo, with disposable applicators and instructions was given to each patient for one week's usage. Patients were demonstrated how to inject 4 g of the trial medication deep into the vagina 2 times daily for 5 consecutive days per week. During the 4-week treatment period, patients were examined on a weekly basis. Cure was defined as absence of clinical signs of infection, as well as PCR and Southern blot hybridization confirmed negative HPV DNA on molecular assay. By the cessation of the therapy 41.7% patients and 44.4% intravaginal warts were cured. Code disclosure revealed that interferon-alpha (2 x 10 6IU/g) in gel had cured 73.3% patients, and 79.3% intravaginal warts, while placebo healed 10% patients and 8.1% lesions (active gel versus placebo; P < 0.0001). Fifty-one patients (85%) complained of no drug-related adverse reactions. Nine patients (15%) mostly alpha in the interferon-alpha gel experienced non-objective, mild headache, tenderness, with transient increase in their body temperature (>38 C). In conclusion, the findings showed that along with non-objective mild side effects, human leukocyte interferon-alpha (2 x 10 6IU/g) in a hydrophilic gel is significantly more effective than placebo to cure intravaginal warts in women.
Changing patterns of HIV transmission and better targeting for intervention strategies
Authors: Ripamonti Diego , Cattane Anna , Donisi Alessandra , Tomasoni Donatella , Milini Paola , Paraninfo Giuseppe , Cadeo Gian Pietro , Carosi Giampiero , Palvarini Loredana , Casari Salvatore
Published: October 2002

We considered the HIV population of our area, comparing demographic characteristics between 2 consecutive 6-year periods to assess the current patterns of HIV transmission. All HIV-positive patients referred to our hospital from January 1985 to December 1996 were included in the study and were classified into 2 periods: A (January 1985 to December 1990) and B (January 1991 to December 1996). The variables analysed were: sex, age at first visit, HIV risk category. A total of 4284 HIV subjects were observed, 2306 in period A vs 1978 in period B (P=ns). Males were 76.3% vs 75.2% (P=ns). Mean age for males was 27.4 vs 32.4 years (P < 0.001) and for females 25.4 vs 30.1 years (P < 0.001). Intravenous drug users (IVDUs) were 88.4% vs 65.4% (P < 0.001), 'heterosexuals' 14.3% vs 24.8% (P < 0.001), 'men who have sex with men' 2.4% vs 4.8% (P < 0.001). Mean age by the main risk groups was: IVDUs 25.9 vs 29.7 years (P < 0.001); heterosexuals 30.4 vs 36 years (P=0.007); 'men who have sex with men' 35 vs 35 years. In conclusion, our study confirms the emerging role of heterosexuals in the current HIV epidemic. People older than teenagers seem to have misperceived their own risk of HIV infection, given the increase in the mean age occurred in the most recent years. This trend suggests the need for prevention strategies focusing more on heterosexual transmission and older people.