Clinical and epidemiological features of HIV infection at a referral clinic in Zambia.

Among 1,350 patients with serologically confirmed HIV-1 infection evaluated at the Dermatovenerealogy Clinic, University Teaching Hospital. Lusaka, through March 1987, 125 (9.3%) had AIDS, 1,178 (87.3%) had AIDS-related complex, and 46 (3.5%) were asymptomatic. The male to female ratio of cases was 1.5:1 and women were younger (mean age of 26.2 years) than were men (mean age of 31.2 years). HIV-infected persons had significantly more lifetime sex partners than uninfected persons; other risk factors were a prior history of venereal disease, blood transfusion, travel abroad, and a positive syphilis serology. Clinical features in decreasing order of frequency were weight loss, persistent generalized lymphadenopathy, chronic cough, multidermatomal herpes zoster, diarrhea, recurrent fevers, tuberculosis, and oropharyngeal candidiasis. The WHO clinical case definition for the diagnosis of AIDS had a low positive predictive value for the 125 Zambians with AIDS, but among all those infected with HIV, the positive predictive value was 76.4%. Thirty (35.3%) of 85 patients who were HIV seronegative when first examined acquired HIV infections during a 12- to 39-month (means = 21.8 months) period of observation. Heterosexual intercourse unrelated to prostitution appears to be the major mode of HIV transmission in Lusaka.

PIP: The clinical and epidemiologic characteristics of the 1st 1350 individuals diagnosed at Zambia's Dermatovenerealogy Clinic in Lusaka between August 1985-December 1986 as a positive for human immunodeficiency virus (HIV) infection were evaluated. 125 (9.3%) of these seropositive individuals presented with aggressive Kaposi's sarcoma or an opportunistic infection and were thus diagnosed with acquired immunodeficiency syndrome (AIDS), 1178 (87.3%) had AIDS-related complex (ARC), and a further 47 (3.5%) were asymptomatic. The male to female ratio of HIV-positive cases was 1.5 to 1. Female patients were younger (mean age 26.1 years) than male patients (mean age, 31.2 years). The only sexual practice acknowledged by the vast majority of cases was heterosexual vaginal intercourse, although infected men and women had significantly more lifetime sexual partners than uninfected controls. Other significant risk factors for HIV seropositivity were (for men) blood transfusion, travel outside of Zambia, and a history of syphilis; for women, these risk factors were blood transfusion and a history of venereal disease. The most common clinical features in AIDS and ARC patients were, in decreasing order of frequency, weight loss greater than 10%, generalized lymphadenopathy, chronic cough, multidermatomal herpes zoster, recurrent diarrhea, recurrent fever, tuberculosis, and oropharyngeal candidiasis. The provisional WHO clinical case definition of AIDS in Africa has a positive predictive value of 82.1 for the sample as a whole, but only 46.3 for the 125 patients diagnosed with AIDS. 17 of the HIV-positive patients had died by the 18-month follow-up.

Epidemiology of human immunodeficiency virus in families in Lusaka, Zambia.

Persons living in the same household as index patients with AIDS or ARC in Lusaka, Zambia were clinically and serologically evaluated for HIV-1 infection. In the 150 households of male index cases, 92 (61.3%) of their spouses were infected, compared with 57 (73.1%) of the spouses of the 78 female index cases. The more advanced the clinical stage of illness in the index cases, the greater the probability of HIV infection in the spouse (RR = 4.44), and the more likely the spouse was symptomatic. Four of the 11 spouses who seroconverted to HIV had also had sexual intercourse at a time when their HIV-infected partner had genital ulcers (RR = 7.45). Of 144 children under 5 years of age, 36 (25.0%) were infected, all had infected mothers and were the last to be borne in all but one household. Three of 120 children 5 to 10 years of age were also infected, presumably through perinatal transmission. Forty-six of 52 discordantly infected couples followed for 1 year continued to have unprotected vaginal intercourse, and 11 (21.2%) of these seroconverted to HIV. There were no HIV infections that could be attributed to transmission by other means than heterosexual intercourse between spouses or by perinatal infection in children borne of infected mothers. The study suggests that there is an increasing risk of HIV heterosexual transmission as infection progresses in the infected partner, and that more effective counseling is needed to prevent it.

PIP: An investigation of members of households of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) in Lusaka, Zambia, revealed a high rate of human immunodeficiency virus (HIV) infection in marital partners, regardless of the sex of the index case. The study, conducted in August 1985-June 1987, involved individuals in 244 households of index patients diagnosed with AIDS or ARC. 92 (61.3%) of the 150 male index cases and 57 (73.1%) of the 71 female index cases had an HIV-infected marital partner, and the severity of HIV disease (AIDS or ARC) in the index partner was linearly associated with the severity of HIV disease in the spouse. 10 (25.6%) of 39 uninfected wives of HIV-positive men compared with only 1 (7.7%) of 13 uninfected husbands seroconverted during the 1st year of follow- up. 4 of the 11 spouses who seroconverted during this period reported sexual intercourse at a time when their HIV-infected partner had genital ulcers. Of the 264 children under 10 years of age from 154 households with an HIV-positive adult who were also evaluated as part of this study, 39 (14.8%) were infected--26 had ARC and 13 had asymptomatic infection. Only 3 of the infected children were older than 5 years of age; the mean was 24.9 months. In all cases, transmission in children was attributable to HIV infection in the mother. These findings suggest a need for more aggressive counseling to reduce the sexual transmission of HIV infection to uninfected partners. 46 of 52 discordantly infected couples followed for 1 year continued to have unprotected vaginal intercourse--a factor that certainly contributed to the high concordance of HIV infection among the couples in this study.

Cutaneous manifestations of human immunodeficiency virus in Lusaka, Zambia.

Of the 1124 human immunodeficiency virus (HIV)-infected patients studied, one or more cutaneous lesions were found in 113 (98.3%) of the 115 patients with acquired immunodeficiency syndrome (AIDS) and in 541 (53.6%) of 1009 patients with AIDS-related complex (ARC). Kaposi's sarcoma, multidermatomal, necrotic herpes zoster, and pruritic maculopapular rashes are common cutaneous manifestations of AIDS and its related complex (ARC) in Zambia. The maculopapular rash results from a lymphoplasmacytic angiitis in the dermis, possibly in response to the presence of HIV in the dermis. Candidiasis, severe genital herpes, extensive molluscum contagiosum, and tinea corporis were less frequent and usually refractory to treatment. Drug reactions are also frequent in Zambians with AIDS. In seven patients given streptomycin, thiacetazone, and rifampicin for treatment of pulmonary tuberculosis, Stevens-Johnson syndrome occurred shortly after therapy was begun, and two died despite high-dose prednisone and discontinuance of tuberculosis therapy. Extensive seborrheic dermatitis refractory to topical fluorinated corticosteroids is also an associated condition in AIDS patients who have pulmonary tuberculosis.

PIP: Cutaneous manifestations of AIDS and AIDS-related complex were studied in a population of 1124 HIV seropositive patients at a hospital in Lusaka, Zambia. 115 of the patients had AIDS, and 1009 had AIDS-related complex. Drug eruptions occurred in 22 patients; 2 died of Stevens-Johnson syndrome subsequent to drug therapy for tuberculosis. The most frequently seen cutaneous manifestations were candidiasis, Kaposi's sarcoma, herpes zoster, seborrheic dermatitis, herpes genitalis, and papular dermatoses. The pruritic maculopapular eruption occurred in crops, healed, and recurred. It was one of the most unique dermatologic manifestations of AIDS found in Africa. Seborrheic dermatitis occurred frequently in patients who also had pulmonary tuberculosis.