Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Most HIV-infection in children occurs in sub-Saharan Africa where antiretroviral therapy is seldom available. This study compares the growth progression and retardation of HIV-infected and uninfected children in the Democratic Republic of Congo (formerly Zaire). It estimates the risk for child growth retardation according to child and maternal immunological factors, severity of maternal and child illness, and maternal socioeconomic and marital status. METHODS: In a prospective cohort study of 258 children born to HIV seropositive mothers and 256 children of seronegative mothers in Kinshasa, Congo, the growth in length, weight, and weight-for-length of infected children (n = 68), uninfected children born to seropositive mothers (n = 190), and uninfected children born to uninfected mothers (n = 256) was compared. Serological, anthropometric and other clinical measures were collected monthly from 3-12 months and bi-monthly during the second year of life. Polymerase chain reaction for HIV was performed on bloods drawn at 2 days and 3 months post partum. Length-for-age, weight-for-age, and weight-for-length mean z-scores against National Center for Health Statistics (NCHS) reference data were calculated, and Cox proportional hazards models were used to estimate the risk of falling below -2.00 z-scores as a function of child and maternal immunological, clinical and sociodemographic variables. RESULTS: There was no difference in mean length-for-age at birth between HIV-infected (Group 1) children, uninfected children of infected mothers (Group 2) or Control children, but by 3 months old, HIV-infected children were shorter than both Group 2 and Controls. In weight-for-age and weight-for-length, Group 1 infants were lighter and more wasted at birth and onwards. Group 2 newborns were lighter than Controls at birth, but by three months they had caught up to Controls in both length and weight and remained the same as Controls thereafter. The odds of falling below -2.00 z-scores by 20 months for length, weight, and weight-for-length for HIV-infected children compared to uninfected children were 2.10, 2.84, and 2.56 respectively. Both HIV-infection and associated illnesses were factors associated with child stunting, underweight and wasting. The mother's age, socioeconomic status, presence of father, stage of illness and immune status had no detectable effect on the child's growth in the first two years of life. CONCLUSION: The HIV-infected children in Congo with no access to antiretroviral therapy were stunted, underweight, and wasted compared to same age uninfected children. Both HIV infection and HIV-associated signs and symptoms, not maternal immunological or socioeconomic circumstances, placed children at risk for growth retardation.

Prevention of sexual transmission of HIV in sub-Saharan Africa: lessons learned.

PIP: More than 80% of cases of HIV infection in Africa are attributed to heterosexual transmission, and most prevention efforts have focused upon checking the sexual spread of HIV. A range of interventions have been implemented over the past 10-15 years in different countries throughout the continent. The nature of the activities depends upon the stage of the epidemic, the target population, the funding level, the level of policy support, donor interests, and the capabilities of implementing agencies in the public and private sectors. Despite reports of some encouraging results, the epidemic remains powerful, dynamic, and spreading. Slowing the HIV/AIDS epidemic in Africa will probably require comprehensive, integrated, and multisectoral programs. Most programs to date, however, intervene almost exclusively at the individual level. The authors describe the evolution of intervention programs to prevent the sexual transmission of HIV in sub-Saharan Africa, discuss lessons learned from programs, and identify gaps in the existing knowledge. Sections review interventions to prevent the sexual transmission of HIV, STD treatment, promoting condoms and making them more available, and behavior change interventions.^ieng

The impact of human immunodeficiency virus infection on pelvic inflammatory disease: a case-control study in Abidjan, Ivory Coast.

OBJECTIVE: Our purpose was to assess the impact of human immunodeficiency virus infection on pelvic inflammatory disease. STUDY DESIGN: A case-control study was performed in Abidjan, Ivory Coast, women with pelvic inflammatory disease, 57 seropositive and 113 seronegative for the human immunodeficiency virus. Women underwent an interview, physical examination, pelvic ultrasonography, and laboratory testing. RESULTS: Seropositive women more often had an oral temperature > or = 38 degrees C (odds ratio 2.5, confidence interval 1.0 to 6.4), a genital ulcer (odds ratio 7.8, confidence interval 1.8 to 45.4), and a tuboovarian mass on ultrasonography (odds ratio 2.6, confidence interval 1.1 to 6.4) and were more likely to require surgery (odds ratio 6.5, confidence interval 1.1 to 67.5) and hospitalization (odds ratio 3.5, confidence interval 0.9 to 14.3). The mean clinical severity score was significantly higher among seropositive than among seronegative patients (17.4 vs 15.4 p = 0.01). Gonorrhea was detected in 50 (29.4%) and chlamydia in 16 (9.4%) of the 170 patients, and neither infection was significantly correlated with human immunodeficiency virus infection. After therapy similar proportions of seropositive and seronegative patients (95% and 93%) reported symptomatic improvement within 4 days, and none had persistent fever at day 4 or 14 of follow-up. CONCLUSIONS: Human immunodeficiency virus infection was associated with more severe clinical manifestations of pelvic inflammatory disease but did not affect microbial cause or response to therapy.

PIP: During October 1992 to July 1993 in Abidjan, Ivory Coast, health workers conducted interviews, physical examinations, pelvic ultrasonography, and laboratory testing with 170 women with pelvic inflammatory disease (PID) at the University Hospital of Treichville and four primary care clinics. They compared clinical and microbiological characteristics and the response to PID therapy in 57 HIV seropositive women (cases) and in 113 HIV seronegative women (controls). Cases were more likely than controls to have a temperature of at least 38 degrees Celsius (odds ratio [OR] = 2.5), a genital ulcer (OR = 7.8), and a tuboovarian mass on ultrasonography (OR = 2.6) and to need surgery (OR = 6.5) and hospitalization (OR = 3.5). They also had a higher clinical severity score than did the controls (17.4 vs. 15.4; p = 0.01). Cases with a lower CD4 count (14%) were significantly more likely than cases with a higher CD4 count to have a temperature of at least 38 degrees Celsius (56% vs. 13-19%; p = 0.03) and dysuria (78% vs. 33-41%; p = 0.05). They also tended to have a genital ulcer and a tuboovarian mass, but not significantly so. Among all 170 women, the most common pathogenic organisms responsible for PID were Neisseria gonorrhoeae (29.4%) and Chlamydia trachomatis (9.4%). Neither infection was significantly related to HIV infection. Yet, the cause of PID in cases with the highest CD4 count was less likely to be N. gonorrhea than that of cases with lower CD4 counts (13% vs. 44%; p = 0.07). Among the 162 women who received oral antibiotics, 95% of the 40 cases and 93% of the controls responded to antibiotic therapy within four days. On days 4 and 14, none of these women still had a fever. These findings suggest that HIV infection affected clinical manifestations of PID but did not affect the cause of PID or response to therapy.