ABSTRACT
AIDS related Kaposi's sarcoma is commonly seen in homosexual men, only occasionally in men and women with heterosexually acquired HIV, and extremely rarely in children. The case of an HIV infected mother and her vertically infected child who both developed visceral Kaposi's sarcoma is reported. It is proposed that the putative Kaposi's sarcoma agent may also be transmitted vertically.
Subject(s)
Acquired Immunodeficiency Syndrome/transmission , Infectious Disease Transmission, Vertical , Sarcoma, Kaposi/etiology , Acquired Immunodeficiency Syndrome/complications , Adult , Child, Preschool , Female , Humans , MaleABSTRACT
Despite advances in antimicrobial and anti-retroviral treatment in the past decade, the natural history of HIV-1 infection remains largely unchanged. Clinical monitoring has led to the introduction of effective prophylaxis of Pneumocystis carinii pneumonia and has facilitated the early detection and treatment of opportunistic infections. Pneumocystis carinii pneumonia now makes up a smaller proportion of first AIDS defining diagnoses than before prophylaxis was introduced. The proportion made up by more unusual opportunistic infections and malignancies, that occur later in the course of the disease, is growing. Late stage HIV disease--which is now complicated by infections with organisms of low pathogenicity, often combined with systemic Kaposi's sarcoma or lymphoma--presents major problems in clinical management. Further changes in the clinical features of HIV-1 infection may be expected in the future as more effective antimicrobial and anti-retroviral treatments are developed.
Subject(s)
HIV Infections/diagnosis , HIV-1 , AIDS-Related Opportunistic Infections , Acquired Immunodeficiency Syndrome/diagnosis , Disease Progression , Humans , Prognosis , United KingdomSubject(s)
Acquired Immunodeficiency Syndrome/therapy , Community Health Services , Female Urogenital Diseases , HIV Infections/therapy , Male Urogenital Diseases , Women's Health Services , Women , Acquired Immunodeficiency Syndrome/diagnosis , Female , Gender Identity , HIV Infections/diagnosis , Humans , MaleABSTRACT
OBJECTIVE: To evaluate a multidisciplinary women-only clinic (WOC) providing HIV testing, HIV follow-up, genitourinary screening and a substance misuse service. The clinic is designed to attract women who are at risk of acquiring sexually transmitted infections, including HIV, yet are not using existing medical services. DESIGN: A questionnaire survey and review of the case notes of women attending the WOC during the first seven months (April to October 1991) and comparison with a mixed-sex, daytime genitourinary clinic (John Hunter Clinic), and a HIV out-patients clinic (Kobler Centre) all within St Stephen's Clinic. RESULTS: One hundred and twenty-nine women attended the WOC over the seven month period and 113 completed a questionnaire. The main reasons for attendance included a preference to be seen by a female doctor and staff, the presence of female patients in the waiting area, and the greater convenience of an evening clinic. In the absence of the WOC over half the patients (56%) indicated that they would not have attended a genitourinary medicine (GUM) clinic. The WOC attracted significantly more new patients than in the JHC (31.5% vs 15% p < 0.001). One hundred and four women (81%) were screened for genitourinary infection. Compared with the JHC there were significantly more cases of genital warts (33.9% vs 16.1% p < 0.001) and candidosis (41.5% vs 22.3% p < 0.001). A greater number of HIV tests were also performed (19% vs 9% p < 0.01). Sixteen (12.4%) women were HIV positive. Their attendance record at both first appointment (88% vs 64% p < 0.05) and subsequent follow-up appointments (81% vs 43% p < 0.05) was significantly higher than a comparable group of women seen by the same doctor (FB) in the Kobler Centre. The women also saw the health adviser more frequently. Although the number of injecting drug users was small (eight), all women currently injecting drugs entered a detoxification programme. CONCLUSION: The WOC has become an established and popular service at St Stephen's. Women not previously using medical services are attending. The multidisciplinary nature of the clinic encourages a wider use of medical and paramedical services. Attendance record for HIV positive women has improved significantly. Whether these factors will lead to improved standards of sexual health will require a longer period of audit. Seventy-nine per cent of women indicated they would use a family planning service if available. An integrated family planning clinic was introduced after the audit period.
