HIV status of female sex partners of men reactive to HIV-1, HIV-2 or both viruses in Abidjan, Côte d'Ivoire.

OBJECTIVES: To compare rates of serologic concordance in the female sex partners of men with HIV-1 and HIV-2 infections, and to determine the serologic status of sex partners of men who reacted serologically to both viruses. DESIGN: Cross-sectional study. SETTING: Infectious diseases service in a University Hospital in Abidjan, Côte d'Ivoire (West Africa). PARTICIPANTS: Hospitalized men reactive on synthetic peptide-based tests to HIV-1, HIV-2 or both viruses (dually reactive), and their spouses visiting them in hospital. OUTCOME MEASURES: Serologic status of female spouses of seropositive men. RESULTS: The serologic status of 540 spouses of 490 HIV-1- and/or HIV-2-positive, hospitalized men was studied. Similar proportions of spouses of HIV-1-infected men (49%) and HIV-2-infected men (44%) were concordantly seropositive. The overall prevalence of infection in spouses of dually reactive men (72%) was significantly higher than in spouses of other men; 44% of these spouses were infected with HIV-1, 8% with HIV-2, and 20% were themselves dually reactive. Considering only the seropositive female spouses of men monotypically reactive to HIV-1 or HIV-2, and the male spouses of women monotypically infected, rates of serologic discordance were significantly greater in men (24%) than women (7%). CONCLUSIONS: Men were likely to have been infected earlier than women because of their HIV-associated illness; also, men more frequently had serologic profiles indicative of infection outside of the union. Rates of serologic concordance in spouses of men with advanced HIV-1 or HIV-2 infection were similar (44-49%). Dually reactive hospitalized men frequently (72%) had seropositive sex partners, most of whom were HIV-1-positive. Dual reactivity was also frequent in these spouses, suggesting transmission of both HIV-1 and HIV-2, or of a cross-reactive strain, and a minority of partners were infected with HIV-2 alone. Prospective studies of discordant couples using quantitative molecular diagnostic techniques are required for better understanding of dual reactivity and transmission of HIV-1 and HIV-2.

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.

Idiopathic CD4+ T-lymphocyte depletion in a west African population.

OBJECTIVE: To assess the frequency of CD4+ T-lymphocyte depletion in selected populations in West Africa and to determine whether an association exists between AIDS-like illnesses and CD4+ T-lymphocytopenia in HIV-negative individuals. DESIGN: Retrospective review of databases and prospective case-control study. SETTING: Project RETRO-CI, an AIDS research project in Abidjan, Côte d'Ivoire, a University Hospital and tuberculosis treatment and maternal and child health centres in Abidjan. METHODS: We conducted a retrospective review of CD4+ T-lymphocyte counts performed between 1991 and 1992 on hospitalized medical patients, outpatients with tuberculosis, and women participating in a study of HIV-1 and HIV-2 mother-to-child transmission. A prospective case-control study was conducted in 1992 to examine the relationship between HIV-negative CD4+ T-lymphocyte depletion and wasting syndrome (wasting and chronic diarrhoea and/or chronic fever). RESULTS: In the retrospective data review, CD4+ T-lymphocyte counts < 300 x 10(6)/l were found in 9.6% of 115 HIV-negative hospitalized patients, in 4.2% of 312 ambulatory tuberculosis patients, and in 0.4% of 263 healthy women after delivery. In the case-control study, no association was found between CD4+ T-lymphocyte depletion in HIV-negative individuals and the presence of wasting syndrome. Increased mortality in HIV-negative individuals was associated with wasting but not with reduced CD4+ T-lymphocyte counts. In contrast, a trend existed for increased mortality with increasingly severe CD4+ T-lymphocyte depletion in HIV-positive patients. Tuberculosis was the most frequently proven or suspected diagnosis in HIV-negative individuals with wasting and CD4+ T-lymphocytopenia. CONCLUSIONS: In the absence of HIV infection, CD4+ T-lymphocytopenia is uncommon (< 1%) in West African asymptomatic individuals but is more frequent in those with tuberculosis (4%) and hospitalized patients (10%). CD4+ T-lymphocytopenia in HIV-negative individuals was not associated with wasting syndrome or increased mortality. There was no evidence for frequent, clinically relevant immune deficiency other than that associated with HIV infection.

The mortality and pathology of HIV infection in a west African city.

BACKGROUND: HIV disease is epidemic in Africa, but associated mortality, underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Côte d'Ivoire, and the pathology of HIV-2 infection in Africa is unclear. METHODS: Consecutive adult medical admissions to a large city hospital in Côte d'Ivoire were studied in 1991, and a sample of HIV-positive deaths autopsied. RESULTS: Of 5401 patients evaluated, 50% were HIV-positive; 38% of these died, with a median survival of 1 week. At autopsy (n = 294, including 24% of HIV-positive deaths in hospital), tuberculosis (TB), bacteraemia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was < 90 x 10(6)/l. Compared with HIV-1-positives, patients with HIV-2-positivity had a greater frequency of severe cytomegalovirus infection, HIV encephalitis and cholangitis. CONCLUSIONS: In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality. The three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable. TB is an underestimated cause of the 'slim' syndrome in Africa. The patterns of pathology in HIV-2-positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries.

Pathogens and predictors of fatal septicemia associated with human immunodeficiency virus infection in Ivory Coast, west Africa.

In East Africa, bacteremia is more common in hospitalized human immunodeficiency virus (HIV) type 1-positive than -negative patients. In 1991, blood cultures and clinical and laboratory data were obtained from 319 patients in Ivory Coast, where both HIV-1 and -2 infections occur. Forty-three bacterial, 10 mycobacterial, and 8 fungal pathogens were isolated from blood of 54 patients (17%). Pathogens isolated significantly (P < or = .05) more frequently from HIV-positive than -negative patients were nonmycobacterial bacteria, particularly Salmonella enteritidis; mycobacteria, particularly Mycobacterium tuberculosis-Mycobacterium bovis; and yeast or fungus. HIV-1 or -2 positivity was associated with a 3-fold increased risk for septicemia (P < .02). HIV-positive patients with fever or with lymphocyte counts < 1000 were more likely to be septicemic than those without these characteristics. Mortality increased significantly with HIV positivity (40% vs. 14%, P < .001) and, among HIV-positive patients, with having pathogens isolated from blood (63% vs. 33%, P < .001).