Human Immunodeficiency Virus and AIDS in Uganda

"HIV-1 infection; initially described as ""slim disease""; was first recognised in Uganda in 1982; and is now a predominant health problem. Approximately 1.5 million Ugandans are now infected; largely through heterosexual transmission. In many areas half of adult deaths are now caused by HIV. Seroprevalence rates in urban antenatal clinics have been dropping in the last several years; as have rates in young adults in two rural community cohorts where the epidemic is long established. Tuberculosis cases and admissions have increased dramatically. among the clinical manifestations of HIV in Uganda; epidemic Kaposi sarcoma; crypotcoccal meningitis; suspected toxoplasmosis and cardiomypathy; as well as atypical or extrapulmonary tuberculosis are seen with increasing frequency. Mother to child transmission of HIV accounts for about 10of total cases; with a transmission rate of 26in two studies. Epidemiological and clinical research programs are well developed in Uganda; especially in areas of tuberculosis; maternal and paediatric HIV infection and sexually transmitted infections. Societal openness; a multisectoral approach by the government and innovative programmes; including large-scale HIV testing and counselling and the pioneering work of The AIDS support Organisation (TASO); distinguish the Ugandan response to the epidemic. Source: East-Afr-Med-J. 1996 Jan; 73(1):20-6."

Effects of combination therapy with low dose fluconazole and flucytosine against cryptococcal; meningitis (CM) in patients in Uganda

From January through July 1994; 58 AIDS patients were enrolled at Mulago Hospital; Makerere Medical School. Of these 58 patients; 30 were assigned to a primary therapy with fluconazole (FLCZ) at a dose of 200mg/day for 2 months and flucytosine (5FC; 150/mg/Kg) for 2 weeks and 28 were assigned to month therapy with FLCZ at the same doze. All the patients who survived for 2 months continued to administrate FLCZ at a doze of 200mg three times per week as a maintenance therapy for 4 months. Fifty patients were evaluated for the survival rate at the end of the therapy for six months. The combination therapy prevented the early death of these patients; while half of patients who received monotherapy died within the first two weeks. The survival rate (32) of 25 patients receiving the combination therapy was significantly higher than that (12) of 25 patients receiving the monotherapy at the end of therapy for 6 months (P0.05). No serious adverse reactions were observed. These data suggest the combination therapy with low dose FLCZ and short course 5FC is cost-effective and safe regimen against CM in AIDS patients in developing countries

Endoscopy versus radiology in African AIDS patients with oesophageal disorders

Upper gastrointestinal endoscopy and double contrast barium radiology were compared prospectively in 45 Ugandan patients with AIDS and upper gastrointestinal oesophageal symptoms. Both investigating techniques were normal as was the histopathology in 5 patients. In 40 cases a definite pathological diagnosis (candidiasis; non-specific inflammation; malignancy) was made. Endoscopic examination provided a correct disgnosis in 38 cases; while only 15 cases were diagnosised from barium studies. Radiology was normal in 2 cases later proved to have definite pathology on endoscopy and histopathologic examination (oesophageal candidiasis). Endoscopy in this series was found to have 95sensitivity in diagnosing oesophageal disorders in AIDS patients; compared to a sensitivty of 37.5for radiology. The difference between the two procedures regarding sensitivity was statistically significant (p0.005). A combination of oral thrush and dysphagia was strongly associated with oesophageal candidiasis (positive predictive value 95; p0.0025). Endoscopy would be the ideal diagnostic procedure for oesophageal candidiasis. The above finding; however; provides a basis for empirical antifungal therapy especially in places where diagnostic facilities are limited

Endoscopy versus radiology in African AIDS patients with oesophageal disorders

Upper gastrointestinal endoscopy and double contrast barium radiology were compared prospectively in 45 Ugandan patients with AIDS and upper gastrointestinal oesophageal symptoms. Both investigating techniques were normal as was the histopathology in 5 patients. In 40 cases a definite pathological diagnosis (candidiasis; non-specific inflammation; malignancy) was made. Endoscopic examination provided a correct disgnosis in 38 cases; while only 15 cases were diagnosised from barium studies. Radiology was normal in 2 cases later proved to have definite pathology on endoscopy and histopathologic examination (oesophageal candidiasis). Endoscopy in this series was found to have 95sensitivity in diagnosing oesophageal disorders in AIDS patients; compared to a sensitivty of 37.5for radiology. The difference between the two procedures regarding sensitivity was statistically significant (p0.005). A combination of oral thrush and dysphagia was strongly associated with oesophageal candidiasis (positive predictive value 95; p0.0025). Endoscopy would be the ideal diagnostic procedure for oesophageal candidiasis. The above finding; however; provide a basis for empirical antifungal theraphy especially in places where diagnostic facilities are limited

The impact of cigarettes smoking on cardiovascular health

The cost of mounting health education programmes to warn people about the dangers of smoking is far below the expensive resources necessary to undertake major palliative operations such as coronary artery bypass grafting and heart-lung transplantation; not to mention the man-power loss due to the smoking-related morbidity and mortality. It means that prevention is better than treatment

The association of genital ulcer disease and HIV infection at a dermatology-STD clinic in Uganda

At Mulago Hospital in Kampala; Uganda; 270 consecutive patients at the dermatology and sexually transmitted disease (STD) clinic were enrolled in a study to evaluate the association of clinical STD syndromes and human immunodeficiency virus (HIV) infection. Female patients became sexually active earlier than male patients and were younger at marriage. Persons with a history of an STD during the preceding 5 years were more likely to be HIV infected (43pc) than those without such a history (26pc; OR 2.08; 95pc C.I. 1.17; 3.73). Examination at the time of the visit demonstrated an association between genital ulcers and HIV infection in male and female patients (OR 2.21; 95pc C.I. 1.08; 4.53; and OR 8.54; 95pc C.I. 1.45; 87.55; respectively) but no association between HIV and urethritis or vaginal discharge. The etiologic fraction for HIV infection of genital ulcers was 0.218. Men with a history of contact with prostitutes were more likely to be HIV infected than those without contact (50pc versus 28pc; p less than 0.05); but once controlled for STDs; this relationship was no longer significant. This study confirms other studies from East Africa that have shown a relationship between genital ulcers and HIV infection. This finding; in the presence of no association between other STD syndromes and HIV infection; suggests that genital ulcers may be truly associated with HIV infection rather than a marker of high-risk activities

A comparison of different treatment regiments for oral thrush

The objective was to compare the effectiveness of 4 different antifungal regimens in the treatment and maintenance of HIV-associated oral thrush (OT). HIV infected patients with OT were randomised to receive ketoconazole 400 mg/day + glutamic acid 340mg/day to (gp 1); ketoconazole 400mg/day PO (gp 2); Miconazole 2oral gel 2.5ml g

Effects of combination therapy with low dose fluconazole and flucytosine against cryptococcal; meningitis (CM) in patients in Uganda

From January through July 1994; 58 AIDS patients were enrolled at Mulago Hospital; Makerere Medical School. Of these 58 patients; 30 were assigned to a primary therapy with fluconazole (FLCZ) at a dose of 200mg/day for 2 months and flucytosine (5FC; 150/mg/Kg) for 2 weeks and 28 were assigned to month therapy with FLCZ at the same doze. All the patients who survived for 2 months continued to administrate FLCZ at a doze of 200mg three times per week as a maintenance therapy for 4 months. Fifty patients were evaluated for the survival rate at the end of the therapy for six months. The combination therapy prevented the early death of these patients; while half of patients who received monotherapy dided within the first two weeks. The survival rate (32) of 25 patients receiving the combination therapy was significantly higher than that (12) of 25 patients receiving the monotherapy at the end of therapy for 6 months (P0.05). No serious adverse reactions were observed. These data suggest the combination therapy with low dose FLCZ and short course 5FC is cost-effective and safe regimen against CM in AIDS patients in developing countries