Human immunodeficiency virus DNA in urethral secretions in men: association with gonococcal urethritis and CD4 cell depletion.

To evaluate the prevalence and correlates of human immunodeficiency virus (HIV)-infected cells in urethral secretions, samples were collected from 106 HIV-seropositive men with and without urethritis. HIV DNA was detected by polymerase chain reaction in 27% of 184 urethral specimens and was associated with CD4 cell depletion (P for trend, .03) and with urethritis (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.6) or gonorrhea (OR, 2.9; 95% CI, 1.5-5.8). Two multivariate models were constructed that included age, CD4 cell count < 200/mm3, and either urethritis or gonococcal infection. Detection of HIV-infected cells in urethral secretions was independently associated with < 200 CD4 cells/mm3 (OR, 2.2; 95% CI, 0.9-5.2; P = .05) and urethritis (OR, 2.7; 95% CI, 1.3-5.3; P = .003) in the first model and with gonococcal infection (OR, 3.2; 95% CI, 1.6-6.4; P < .001) in the second model. Successful treatment of gonococcal urethritis was associated with a 2-fold reduction in urethral HIV DNA (44% vs. 21%; P = .02). Thus, treatment of gonococcal urethritis may be an effective strategy for reducing HIV transmission.

The epidemiology of needlestick and sharp instrument accidents in a Nigerian hospital.

OBJECTIVES: To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria. DESIGN: A cross-sectional survey of a random sample of HCWs regarding details of needlestick and sharp instrument injuries within the previous year. SETTING: University hospital and clinics in Ile-Ife, Nigeria. PARTICIPANTS: Hospital personnel with potential occupational exposure to patients' blood. RESULTS: Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in 18%, and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of HCWs and most commonly involved broken glass patient specimen containers (39%). Almost all HCWs were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition. CONCLUSIONS: The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.

PIP: During the spring of 1991 in Nigeria, 474 health care workers (HCWs) of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Ile-Ife responded to a questionnaire on needlestick and sharp instrument injuries they had experienced in the last year and on their knowledge of HIV transmission. Current HIV seroprevalence at OAUTHC was less than 2%. 97% knew that an HIV-contaminated needlestick or skin penetration with HIV-infected blood could transmit HIV. 91% were very worried about occupational exposure to HIV. Gloves were always available to only 43%. 34% had experienced at least one accidental percutaneous injury due to a needle stick or sharp instrument during the last 12 months. The rate of percutaneous injuries was 0.8 per person-year. 27% (126) reported at least one needlestick injury. The rate of needlestick injury was 0.6 per person-year. 39 HCWs experienced at least 3 needlestick injuries. Dentists, surgeons, and mortuary attendants experienced the most needlestick injuries (100%, 81%, and 60%, respectively). The most common needlestick injuries occurred during suturing (24%), intramuscular injection (23%), and handling or disposal of used needles (23%). Unexpected patient movement (29%), needle recapping (18%), and accidental stick by colleague accounted for needlestick injuries. 15% (69) of HCWs reported at least one sharp instrument injury. 12 HCWs had at least 3 sharp instrument injuries. HCWs most affected by sharp instrument injuries were dental therapists/assistants (42%), dentists (40%), mortuary attendants (40%), surgeons (35%), and laboratory staff (25%). Broken glass containers containing patient specimens (39%), scalpels (32%), and dental instruments (20%) contributed to most injuries by sharp objects. Some possible cost-effective interventions to prevent occupational exposure to HIV among HCWs include educational seminars, preparation of patients before procedures to reduce unexpected patient movement, and infection control committees.

Detection of HIV DNA in cervical and vaginal secretions. Prevalence and correlates among women in Nairobi, Kenya.

OBJECTIVE: Factors that influence heterosexual transmission of the human immunodeficiency virus (HIV), including sexually transmitted diseases, contraceptive practices, sexual practices, HIV-related immunosuppression, and presence of cervical ectopy and the penile foreskin, have been identified through cross-sectional and prospective cohort epidemiological studies. To more directly characterize factors that influence infectivity, we conducted a study of HIV shedding from the genital tract in women. DESIGN: Ninety-seven HIV-seropositive women attending a sexually transmitted disease clinic in Nairobi, Kenya, completed a questionnaire and underwent a physical examination and an evaluation for sexually transmitted diseases. Cervical and vaginal secretions were obtained for HIV DNA detection using polymerase chain reaction amplification. RESULTS: Human immunodeficiency virus DNA was detected by polymerase chain reaction in 28 (33%) of 84 cervical samples and 13 (17%) of 77 vaginal samples. The prevalence of HIV was higher in specimens from the endocervix than from the vaginal wall (P = .002), and there was no correlation between presence of virus at the two sites. After adjusting for age, cervical HIV shedding was independently associated with oral contraceptive pill use (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.7 to 77.6), cervical mucopus (OR, 6.2; 95% CI, 0.9 to 41.4; P = .05), cervical ectopy (OR, 5.0; 95% CI, 1.5 to 16.9), and pregnancy (OR, 4.5; 95% CI, 1.2 to 16.3). CONCLUSIONS: Human immunodeficiency virus was detected in one third of cervical samples and one sixth of vaginal samples. The presence of HIV DNA in cervical secretions was significantly associated with oral contraceptive pill use, cervical ectopy, and pregnancy. There was a marginally significant association with cervical mucopus. The identification of factors that increase the infectivity of women suggests potential strategies for reducing heterosexual transmission of HIV.

Beta-2 microglobulin as a marker of HIV disease status in Nairobi, Kenya.

Serum beta-2 microglobulin (beta 2-M) has prognostic value similar to lymphocyte profiles for predicting disease progression in those infected with the human immunodeficiency virus (HIV). However, the relationship between beta 2-M and HIV disease progression among inhabitants of countries with endemic tropical diseases has not been evaluated. To determine the relationship between serum beta 2-M levels and HIV infection and disease status in an African population, serum beta 2-M levels were measured in 369 patients attending a sexually transmitted disease (STD) clinic in Nairobi, Kenya. Mean serum beta 2-M was significantly higher in HIV seropositive than in HIV seronegative individuals. Among HIV infected patients, higher mean beta 2-M levels were observed in those with HIV associated symptoms or laboratory markers of advanced HIV disease. Significant inverse correlations between beta 2-M and the percentage of CD4 lymphocytes or CD4/CD8 ratio were found. These findings suggest that beta 2-M measurements may have prognostic value for HIV infected populations in developing countries.

Association of cervical ectopy with heterosexual transmission of human immunodeficiency virus: results of a study of couples in Nairobi, Kenya.

To identify risk factors involved in heterosexual transmission of human immunodeficiency virus (HIV), a cross-sectional study of HIV-seropositive men and their spouses was conducted in Nairobi, Kenya. Of 70 spouses, 40 (57%) were seropositive and 30 (43%) were seronegative for HIV. In univariate analysis, the presence of cervical ectopy (odds ratio, 4.7; P = .006) was the only statistically significant variable associated with HIV infection in women. After controlling for possible confounding variables using multivariate logistic regression analysis, the presence of cervical ectopy (odds ratio, 5.0; P = .007) remained the only independent predictor of HIV seropositivity. These findings suggest that cervical ectopy may be a newly identified risk factor for heterosexual transmission of HIV.

The interrelationship between human immunodeficiency virus infection and other sexually transmitted diseases.

The epidemiology of HIV infection in the United States is changing, with a dramatic reduction in the incidence of new HIV infection in homosexual men over the past decade because of altered sexual practices. In contrast, heterosexual transmission of HIV is increasing and is disproportionately occurring in inner city racial minorities in association with drug use, populations that are currently experiencing epidemics of previously controlled STDs. Sexually transmitted diseases, especially genital ulcerative diseases and perhaps C. trachomatis and T. vaginalis, facilitate sexual transmission of HIV. In addition, HIV infection itself appears to increase the severity of certain STDs once they are acquired. The control of STDs, particularly in those populations that are at high risk for HIV infection, should be of high priority and should be an integral component of AIDS control programs.

Evaluation of a rapid membrane-based assay (HIV-CHEK) for detection of antibodies to HIV in serum samples from Nairobi.

We evaluated a rapid membrane-based assay (HIV-CHEK) for detection of antibodies to HIV using 737 serum samples in Nairobi, Kenya. The rapid assay had a sensitivity of 96.3% and specificity of 99.8% when compared with enzyme-linked immunosorbent assay (ELISA) and Western blot assay. Results were similar using fresh or previously frozen serum samples, although the latter occasionally left debris on the assay device membrane yielding uninterpretable results. This rapid HIV assay may be of particular use in developing countries where laboratory resources are limited.