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1996-03-09
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Document 0181
DOCN M9650181
TI AIDS in Africans living in London.
DT 9605
AU O'Farrell N; Lau R; Yoganathan K; Bradbeer CS; Griffin GE; Pozniak AL;
Department of Genitourinary Medicine, Guy's Hospital, London.
SO Genitourin Med. 1995 Dec;71(6):358-62. Unique Identifier : AIDSLINE
MED/96164964
AB OBJECTIVES--To investigate the presentation of HIV infection and AIDS
amongst Africans diagnosed with AIDS living in London.
METHODS--Identification of all AIDS cases of African origin attending
four HIV specialist centres in South London--Guy's, King's, St George's
and St Thomas' Hospitals--up to March 1994, by retrospective review of
case notes of all HIV positive patients. RESULTS--Of 86 patients (53
women, 33 men) studied, 59 (69%) were from Uganda. The most frequent
AIDS-defining diagnoses were: Pneumocystis carinii pneumonia (PCP) 21%,
tuberculosis (TB) 20% (extrapulmonary TB 14%, pulmonary TB 6%), cerebral
toxoplasmosis 14%, oesophageal candida 13%, cryptococcal meningitis 11%,
wasting 6%, herpes simplex infection > 1 month 5%, Kaposi's sarcoma 5%,
other 6%. Cytomegalovirus retinitis was diagnosed in one case. Late
presentation was common; 70% were diagnosed HIV positive when admitted
to hospital. The diagnosis of AIDS was coincident with a first positive
HIV test result in 61%. The mean CD4 counts at both HIV and AIDS
diagnoses were similar in both men and women: 87 x 10(6)/l and 74 x
10(6)/l in men and 99 x 10(6)/l and 93 x 10(6)/l in women respectively.
Overall, TB 21 (24%) (extrapulmonary TB 12, pulmonary TB 9) was either
the AIDS-defining diagnosis or was detected within three months of this
event. Sixty-two per cent of TB cases were diagnosed within twelve
months of entry to the UK compared to 34% of all other AIDS cases. The
prevalence of STD was very low; genital herpes was the commonest STD:
17% of the women, 9% men; 28% of the men and 11% of the women tested had
a positive TPHA test. In cases known to be HIV-positive prior to an AIDS
diagnosis, 41% took prophylaxis for PCP and 45% had taken zidovudine
(ZDV). Forty two of the study participants had 89 children: 59 of these
children had mothers in the study. Overall, 37 (42%) of the children had
lost at least one parent at the time of data assessment.
CONCLUSIONS--PCP and TB were the most common initial AIDS-defining
diagnoses. The majority of TB cases were diagnosed within 12 months of
entry to the UK. An AIDS-defining diagnosis was the first manifestation
of HIV-related illness in the majority of patients. Because of late
presentation to medical services, access to treatments for HIV infection
and prophylaxis against opportunistic infections was limited. Extending
the role of clinics and staff into the community might facilitate both
earlier presentation and access to services. Future provision of local
services will need to be sensitive to the requirements of individuals
from different cultures and backgrounds.
DE Acquired Immunodeficiency Syndrome/DRUG THERAPY/*ETHNOLOGY Adult
Africa/ETHNOLOGY Antiviral Agents/THERAPEUTIC USE Female Human HIV
Infections/DIAGNOSIS London/EPIDEMIOLOGY Male Middle Age Pneumonia,
Pneumocystis carinii/DIAGNOSIS/PREVENTION & CONTROL Retrospective
Studies Tuberculosis/DIAGNOSIS Zidovudine/THERAPEUTIC USE JOURNAL
ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).