RESUMO
OBJECTIVE: A study was conducted to define the natural history and disease progression of HIV infection in a developing country. DESIGN: A prospective longitudinal cohort study. METHODS: Forty-two patients with documented dates of HIV seroconversion were followed in Port-au-Prince, Haiti. Patients were seen at 3 month intervals or when ill. Patients were treated for bacterial, mycobacterial, parasitic, and fungal infections, but antiretroviral therapy was not available. Patients were followed until death or until 1 January 2000; median follow-up was 66 months. RESULTS: By Kaplan-Meier analyses, the median time to symptomatic HIV disease (CDC category B or C) was 3.0 years [95% confidence interval (CI) 2.3-5.0 years]. The median time to AIDS (CDC category C) was 5.2 years (95% CI 4.7-6.5 years), and the median time to death was 7.4 years (95% CI 6.2-10.2 years). Community-acquired infections, including respiratory tract infections, acute diarrhea, and skin infections were common in the pre-AIDS period. AIDS-defining illnesses included tuberculosis, wasting syndrome, cryptosporidiosis, cyclosporiasis, candida esophagitis, toxoplasmosis, and cryptococcal meningitis. Rapid progression to death was associated with anemia at the time of seroconversion hazards ratio (HR) 4.1 (95% CI 1.1-15.0), age greater than 35 years at seroconversion HR 4.4 (95% CI 1.1-16.6), and lymphopenia at seroconversion HR 11.0 (95% CI 2.3-53.0). CONCLUSION: This report documents rapid disease progression from HIV seroconversion until death among patients living in a developing country. Interventions, including nutritional support and prophylaxis of common community-acquired infections during the pre-AIDS period may slow disease progression and prolong life for HIV-infected individuals in less-developed countries.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/fisiopatologia , Adulto , Estudos de Coortes , Progressão da Doença , Feminino , Haiti/epidemiologia , Humanos , Estudos Longitudinais , MasculinoRESUMO
BACKGROUND: Despite the importance of human immunodeficiency virus (HIV) transmission through heterosexual contact, the incidence of HIV infection in heterosexual cohorts has not been well studied, particularly in the developing world. OBJECTIVE: To 1) determine the incidence of HIV infection in discordant heterosexual couples (couples in which one partner had HIV infection and the other did not) in Haiti and 2) assess risk factors for and methods of preventing HIV infection. DESIGN: Prospective study. SETTING: National Institute for Laboratory Research, Portau-Prince, Haiti. PARTICIPANTS: 475 HIV-infected patients and their noninfected regular sex partners. MEASUREMENTS: Patients and their partners were evaluated at 3- to 6-month intervals for HIV infection, sexually transmitted diseases, and sexual practices. The efficacy of counseling and provision of free condoms was also evaluated. RESULTS: Among the 177 couples who remained sexually active during the prospective study period, 20 seroconversions to HIV positivity occurred, for an incidence rate of 5.4 per 100 person-years (95% CI, 5.16 to 5.64 per 100 person-years). Thirty-eight couples (21.5%) discontinued sexual activity during the study. Only 1 seroconversion occurred among the 42 sexually active couples (23.7% of the 177 sexually active couples) who always used condoms. In contrast, the incidence in sexually active couples who infrequently used or did not use condoms was 6.8 per 100 person-years (CI, 6.49 to 7.14 per 100 person-years). Transmission of HIV was associated with genital ulcer disease, syphilis, and vaginal or penile discharge in the HIV-negative partner and with syphilis in the HIV-infected partner. CONCLUSION: Counseling and the provision of free condoms contributed to the institution of safe sex practices or abstinence in 45% of discordant heterosexual couples. However, 55% of couples reported that they continued to have unprotected sex, resulting in an incidence of HIV infection of 6.8 per 100 person-years.
PIP: A prospective study of 475 individuals infected with human immunodeficiency virus (HIV) and their non-infected regular sex partners indicated that discordant heterosexual couples comprise a major source of acquired immunodeficiency syndrome (AIDS) spread in Haiti. Participants were recruited from the National Institute for Laboratory Research in Port-au-Prince. Of the 2687 HIV-positive individuals who returned to the Institute during 1988-92 to obtain their HIV test result, 1201 brought in a regular sexual partner for testing; 583 (49%) of these partners were HIV-negative. Discordant couples received free condoms and counseling and were evaluated at 3-month intervals. Sexual activity was discontinued by 298 (63%) of couples within 6 months of study entry, largely because of advanced AIDS. Overall, 20 sex partners seroconverted after a median follow-up of 27 months. Seroconversion was associated with non-use of condoms (relative risk, 6.8/100 person-years), the presence of genital ulcer disease in the initially HIV-negative partner (6.55), and syphilis in the HIV-infected index patient (2.9). Counseling increased condom use from none at study entry to 24%. The rate of seroconversion in those who always used condoms was only 1/100 person-years.
Assuntos
Infecções por HIV/transmissão , Comportamento Sexual , Preservativos , Feminino , Infecções por HIV/etiologia , Infecções por HIV/prevenção & controle , Soropositividade para HIV/transmissão , Haiti , Humanos , Incidência , Masculino , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
Human immunodeficiency virus (HIV) infection is spreading rapidly in Haiti with HIV seroprevalence rates of 10% and 3% in urban and rural areas, respectively. Since 1985, heterosexual transmission has been the primary mode of acquisition of HIV. From 1981 to the present, the Cornell-GHESKIO unit in Port-au-Prince, Haiti, has developed the infrastructure to recruit and retain large cohorts of individuals at risk for HIV infection. Among the populations studied, couples discordant for HIV infection appear most suitable for eventual HIV phase III vaccine trial. This paper describes the recruitment, retention, and characteristics of the discordant-couples cohort, as well as the limitations of interventions aimed at behavior modification.
Assuntos
Vacinas contra a AIDS/farmacologia , Ensaios Clínicos como Assunto/métodos , Infecções por HIV/prevenção & controle , Estudos de Coortes , Feminino , Infecções por HIV/transmissão , Haiti , Humanos , Masculino , Seleção de Pacientes , Comportamento Sexual , Parceiros SexuaisRESUMO
An observational study of 140 HIV-seropositive asymptomatic women of childbearing age was conducted in Haiti from 1984 to 1992 as part of a larger natural history study. Forty-four women were pregnant or became pregnant during the study period. The progression to HIV-related disease, AIDS, and mortality from AIDS was compared in the pregnant and nonpregnant cohorts. The mean follow-up time was 44 months. Overall, 32 of the 140 women (38%) developed AIDS, and 26 (19%) died from AIDS during the study period, with a cumulative AIDS incidence rate of 16% at 3 years after study entry. There was a trend toward earlier manifestation of HIV-related symptoms among the pregnant cohort, but no significant difference was observed in the rate of progression to AIDS or death between the pregnant and nonpregnant women.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Soropositividade para HIV/fisiopatologia , Adulto , Peso Corporal , Feminino , Soropositividade para HIV/complicações , Haiti , Humanos , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Estudos Prospectivos , Análise de Sobrevida , Fatores de TempoRESUMO
AIDS is inexorably involving all parts of the country and all strata of society, with 10% of the urban and 3% of the rural population infected with HIV. It is increasingly a disease of women and children. The major cofactors for transmission are also sexually transmitted. For most developing countries, in spite of all education efforts, the "silent epidemic" of AIDS continues. AIDS is known but not understood; counselling modifies behavior in only 10-20% of at-risk persons. Under optimal conditions, HIV discordant females have seroconversion rates of 4.7% per year and pregnancy rates of 10.4% per year. The recent political unrest in Zaire and Haiti will further enhance the spread of AIDS in these countries. Despite these difficult periods, the work can and must continue. After all, during our 10th year of collaboration with a Haitian private research group, the Haitian government and Cornell University, Haiti has known seven different political rulers. Finally, I want to make a pledge on behalf of the millions of people who face a certain death from HIV infection and AIDS and who will never make the front page of any newspaper. For these people, you can make a difference. You must give us the tools to carry on this fight. The clinical trials must be done where they are most needed: the developing countries. Vaccines represent the only viable alternative despite the recognized obstacles of viral heterogeneity, immunogenicity, and delivery.
Assuntos
Vacinas contra a AIDS , Países em Desenvolvimento , Infecções por HIV/prevenção & controle , Adulto , Atitude Frente a Saúde , Estudos de Coortes , Cultura , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Soroprevalência de HIV , Haiti/epidemiologia , Humanos , Incidência , Recém-Nascido , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Fatores de Risco , Comportamento SexualRESUMO
The prevalence of antibodies to human immunodeficiency virus (HIV) was determined in the relatives, friends, and sex partners of AIDS patients in Haiti and in other unrelated Haitian population groups. Among contacts of AIDS patients, HIV seroprevalence was highest among sex partners of the opposite sex (55%) and lowest among female relatives and friends (9%) of female AIDS patients. Male relatives and friends of male AIDS patients had a seroprevalence rate of 19% and also had a history of multiple heterosexual partners and frequent contact with prostitutes. The HIV seroprevalence rate among unrelated groups of Haitian adults ranged from 2% in rural healthy adults to 22% among tuberculosis patients to a high of 49% among Haitian prostitutes. This seroprevalence pattern suggests that HIV infection is widespread in Haiti and that heterosexual activity plays a major role in transmission.
Assuntos
Infecções por HIV/epidemiologia , Soroprevalência de HIV , Comportamento Sexual , Bissexualidade , Transfusão de Sangue , Estudos de Casos e Controles , Feminino , Infecções por HIV/transmissão , Haiti/epidemiologia , Humanos , Masculino , Prevalência , Estudos Prospectivos , Fatores de Risco , População Rural , Fatores Sexuais , Trabalho Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Sorodiagnóstico da Sífilis , População UrbanaRESUMO
During July 1983 to December 1984, we observed that 62 (46%) of 134 Haitian patients with acquired immunodeficiency syndrome had intensely pruritic eruptions for which neither specific causative nor categoric diagnoses could be established. These lesions were a presenting manifestation of acquired immunodeficiency syndrome in 79% of the patients and appeared a mean of 8 months before the diagnosis of either Kaposi's sarcoma or opportunistic infection. Lesions included erythematous round macules, papules, or nodules that first appeared on the extensor surface of the arms, but subsequently involved the legs, trunk, and face. Histologically, the lesions were characterized by varying degrees of mixed (predominantly eosinophilic) perivascular and perifollicular inflammatory cell infiltrates of the dermis. The lesions did not respond to any therapeutic regimens used and usually persisted throughout the acquired immunodeficiency syndrome illness. Demographic and laboratory data did not distinguish these patients from those without pruritic skin lesions.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Prurido/etiologia , Dermatopatias/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Haiti , Humanos , Mordeduras e Picadas de Insetos/patologia , Masculino , Prurido/epidemiologia , Prurido/patologia , Pele/patologia , Dermatopatias/epidemiologia , Dermatopatias/patologiaRESUMO
We conducted a randomized prospective study to compare the efficacy of oral miconazole and ketoconazole in the treatment of candida esophagitis in acquired immune deficiency syndrome (AIDS) patients in Haiti. Twelve AIDS patients with endoscopic and microscopic diagnoses of candida esophagitis were placed on either oral miconazole or ketoconazole for 10 days. All six patients receiving oral miconazole, and four of the six receiving ketoconazole had complete resolution of their esophageal lesions at the end of treatment. We conclude oral miconazole is at least as effective as ketoconazole in the treatment of candida esophagitis in AIDS patients.